Multiple sclerosis (MS) does not increase risks from cardiovascular surgery and should not preclude patients from procedures, new research suggests.

The US study found that in-hospital mortality rates following cardiovascular surgery were comparable for patients with or without MS, as was the prevalence of a composite complication endpoint.

The cost and length of hospital stay were also comparable, although MS patients were less frequently subject to routine home discharge.

“MS may not be considered a contraindication to cardiovascular surgery based on in-hospital mortality risk,” wrote the authors, led by Dr Jose Diz Ferre of the Cleveland Clinic, Ohio, USA.

“Instead, preoperative planning should emphasise coordination with neurology and explicit assessment for autonomic dysfunction to reduce perioperative complications or disease relapses,” they added.

The study, published in JAMA Surgery [link here], analysed data on 1,766,170 US patients who underwent coronary artery bypass grafting, valve, aortic, or combined cardiovascular surgery between 2016 and 2022, of whom 3,605 (0.2%) had MS.

The MS cohort more commonly had comorbidities, including chronic lung disease, depression, hypothyroidism, paralysis, psychosis, and valvular disease, compared to controls.

In matched cohorts of 3,530 patients, MS patients had similar rates of in-hospital mortality to controls (2.0% vs 3.7%, p=0.05).

MS patients and controls also showed a similar risk of a composite complication endpoint (50% vs 51%, p=0.67) that included stroke, acute kidney failure, pulmonary embolism, deep vein thrombosis, gastrointestinal (GI) and non-GI bleeding, prolonged mechanical ventilation, tracheostomy, pneumonia, surgical site infection, sepsis, blood transfusion, pericardial effusion, fluid overload and pacemaker requirement.

However, MS patients had a lower prevalence of acute kidney failure (1.6% vs 4.0%, p=0.006) and GI bleeding (0.8% vs 2.4%, p=0.02), although they were also less frequently routinely discharged to home (28% vs 36%, p<0.001).

“Surgeons may consider a team approach with neurological experts to optimise perioperative care and increase routine home discharges,” the authors concluded.