To conduct a systematic review and meta-analysis to summarize the existing evidence about the background of recent surgery as a risk factor forGuillain-Barre Syndrome (GBS)

Previous studies point to surgery as a trigger for GBS. The mechanism, yet unclear, proposes that immunosuppression resulting from these interventions could lead to subclinical infections related to this syndrome. Other theory states that surgery itself could release autoantigens that through molecular mimicry would induce the immune reaction against the nervous system.

A systematic search was conducted in PubMed, Embase and Web of Science until April 2024. The risk of bias was assessed with the NewCastle-Ottawa (NOS) tool and The Joanna Briggs Institute (JBI) Critical Appraisal Checklist. A meta-analysis with randomized effects model was applied using the DerSimonian-Laird estimator to calculate the pooled effect of the outcome and a narrative synthesis when this was not possible. GRADE criteria for dichotomous outcomes and narrative review were used to assess the certainty of the evidence.

Twelve out of 595 articles were reviewed. With high certainty, an adjusted Odds Ratio meta analysis showed that any recent surgery was associated to GBS (OR: 1.62; 95%CI: 1.40-1.88; I2=0%). Subgroup analysis according type of surgery found significant association with gastrointestinal surgery only (OR: 2.25; 95%CI: 1.55-3.25; I2=0%). Reviewed articles reported that surgical exposure was associated with Acute Motor Axonal Neuropathy (AMAN) electrophysiological subtype and higher severity assessed by Hughes Functional Grading Scale (HFGS) in GBS patients.

With high certainty, we found that individuals with surgery history have a higher risk of developing GBS, furthermore, this exposure would be associated with the clinical course of this disease. More studies are needed to elucidate the pathophysiology and relevance of previous surgery in GBS patients.