{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T04:28:35Z","timestamp":1781152115090,"version":"3.54.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Surgery is a common exposure. Multiple sclerosis (MS) is a chronic neuroinflammatory demyelinating disease of the central nervous system and a systemic inflammatory activation caused by surgery may result in exacerbation of the disease. It is unknown how surgical procedures affect morbidity and mortality rates in MS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aimed to investigate morbidity associated with surgical interventions in MS patients by assessing disease burden before and after surgery. Non-MS patients were used as controls, allowing for comparisons of disease burden and mortality between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The cohort study analyzed data from the Swedish Perioperative Register, including 3,022 MS patients among over 1.5 million surgeries performed between January 2019 and March 2023. Disease burden was measured as the number of pre-specified ICD-codes before and after surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We demonstrated that MS patients exhibited a higher mean number of diagnoses before and after surgery compared to controls. Specifically, the number of diagnoses peaked in the first month post-surgery but returned to baseline within three to 4\u202fmonths. Notably, there were no significant differences in 30-day or 365-day mortality rates between MS and non-MS patients, highlighting the relative safety of surgical interventions for persons with MS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The findings suggest that surgery is generally safe for patients with MS, indicating that MS should not preclude necessary surgical interventions. Nevertheless, tailored preoperative assessments and postoperative care strategies are essential to address the unique health challenges encountered by MS patients, ensuring optimal surgical outcomes and monitoring for potential complications.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1573349","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T04:10:46Z","timestamp":1750911046000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of surgery in patients with multiple sclerosis: a nationwide cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Emma","family":"Larsson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Iacobaeus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"von Oelreich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesper","family":"Eriksson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"K\u00e5hlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"S11","DOI":"10.1016\/S0140-6736(15)60806-6","article-title":"Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes","volume":"385","author":"Weiser","year":"2015","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising prevalence of multiple sclerosis worldwide: insights from the atlas of MS, third edition","volume":"26","author":"Walton","year":"2020","journal-title":"Mult Scler"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S6","DOI":"10.1002\/ana.410360704","article-title":"Natural history of multiple sclerosis","volume":"36","author":"Weinshenker","year":"1994","journal-title":"Ann Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1336","DOI":"10.1177\/1352458513475833","article-title":"High risk of cardiovascular diseases after diagnosis of multiple sclerosis","volume":"19","author":"Jadidi","year":"2013","journal-title":"Mult Scler"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1212\/01.wnl.0000333252.78173.5f","article-title":"Comorbidity delays diagnosis and increases disability at diagnosis in MS","volume":"72","author":"Marrie","year":"2009","journal-title":"Neurology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e446","DOI":"10.1212\/WNL.0000000000010024","article-title":"Comorbidity is associated with disease activity in MS: findings from the Combi Rx trial","volume":"95","author":"Salter","year":"2020","journal-title":"Neurology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2455","DOI":"10.1212\/WNL.0000000000004716","article-title":"Comorbidity increases the risk of relapse in multiple sclerosis: a prospective study","volume":"89","author":"Kowalec","year":"2017","journal-title":"Neurology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2112","DOI":"10.1212\/WNL.0000000000000495","article-title":"Intensive care unit admission in multiple sclerosis: increased incidence and increased mortality","volume":"82","author":"Marrie","year":"2014","journal-title":"Neurology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1007\/s11695-023-06633-z","article-title":"Effect of metabolic and bariatric surgery on the clinical course of multiple sclerosis in patients with severe obesity: a systematic review","volume":"33","author":"Shahsavan","year":"2023","journal-title":"Obes Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.1177\/1352458519860304","article-title":"Multiple sclerosis relapse risk in the postoperative period: effects of invasive surgery and anesthesia","volume":"26","author":"De Lott","year":"2020","journal-title":"Mult Scler"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1056\/NEJM199807303390501","article-title":"Rate of pregnancy-related relapse in multiple sclerosis. 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