Abstract Details

Prior literature has shown that biological sex influences outcomes across a myriad of medical and surgical conditions. Little is known about how sex influences inpatient outcomes for adult patients undergoing acute hospitalization for myasthenic crisis. 

To assess whether sex differences influence inpatient outcomes of patients hospitalized for myasthenic crises.

The 2006 to 2014 National Inpatient Sample database was queried using the International Classification of Diseases 9th Edition (ICD-9) diagnosis code (358.01) to identify adult patients (age >18 years) undergoing hospitalization for myasthenic crisis. Inpatient complications that were assessed as part of the study included urinary tract infections, acute renal failure, cardiac complications, systemic infection, deep venous thrombosis, and pulmonary embolism. Multivariate logistic regression analyses was used to assess differences in inpatient outcomes between males and females, after controlling for baseline age, gender, insurance type, median household income, co-morbidities), hospital characteristics (bed size, and location and teaching status), and treatment factors (use of endotracheal intubation or non-invasive mechanical ventilation, thymectomy, and receipt of intravenous immunoglobulin [IVIG] or plasmapheresis [PLEX]). For regression purposes, female gender was used as a reference.

A total of 56,189 patients were included – out of which 31,599 (56.2%) were female, 24,561 (43.7%) were male and 29 (0.1%) were unknown. Multivariate analyses showed that males (vs. females) had lower odds of experiencing urinary tract infections (OR 0.38 [95% CI 0.36-0.40]; p<0.001), but higher odds of experiencing cardiac complications (OR 1.13 [95% CI 1.01-1.27]; p=0.030), systemic infections (OR 1.28 [95% CI 1.16-1.42]; p<0.001), and acute renal failure (OR 1.47 [95% CI 1.37-1.59]; p<0.001).

Male patients experience significantly worse outcomes, in terms of complication rates, following hospitalization for myasthenic crisis. These findings underscore the importance of not only using gender as a risk-prediction tool, but also tailoring inpatient care pathways and health resources utilization to provide equitable care.