PMID- 23861140
OWN - NLM
STAT- MEDLINE
DCOM- 20140123
LR  - 20220409
IS  - 2151-4658 (Electronic)
IS  - 2151-464X (Linking)
VI  - 65
IP  - 12
DP  - 2013 Dec
TI  - Infection risk after orthopedic surgery in patients with inflammatory rheumatic 
      diseases treated with immunosuppressive drugs.
PG  - 2032-40
LID - 10.1002/acr.22077 [doi]
AB  - OBJECTIVE: The influence of specific medications on the risk of postoperative 
      infection in patients with rheumatoid arthritis and other inflammatory rheumatic 
      diseases (IRDs) remains unclear. This retrospective study examined the risk of 
      postoperative infection at the site of surgery in patients treated with 
      immunosuppressive drugs (including biologic agents) undergoing different types of 
      orthopedic surgery. METHODS: The study included 50,359 cases of orthopedic 
      surgery performed in our hospital between 2000 and 2008. The primary outcome was 
      operation-related infection. IRD patients were compared with those with 
      degenerative or posttraumatic disorders, and in IRD patients, the effect of 
      immunosuppressive medication, specifically tumor necrosis factor alpha (TNFalpha) 
      inhibitors and their preoperative management, was examined. RESULTS: There were 
      373 operation-related infections (0.8%) of 47,887 cases in the 
      degenerative/posttraumatic group and 49 (2.0%) of 2,472 in the IRD group (higher 
      infection rate in the IRD group; odds ratio [OR] 2.58 [95% confidence interval 
      (95% CI) 1.91-3.48], P < 0.001). In the IRD group, elbow and foot surgery had the 
      highest infection rates. The risk of infection was significantly increased in 
      patients taking multiple conventional disease-modifying antirheumatic drugs 
      (DMARDs; OR 2.49 [95% CI 1.06-5.84], P = 0.036) or TNFalpha inhibitors (OR 2.54 [95% 
      CI 1.08-5.97], P = 0.032). The risk was especially high (6 [12%] of 49) if the 
      last dose of TNFalpha inhibitor was given <1 administration interval before surgery. 
      CONCLUSION: The risk of postoperative infection was elevated in patients with 
      IRDs, especially those taking >1 conventional DMARD or TNFalpha inhibitors. It may be 
      advisable to consider stopping TNFalpha inhibitors >/=1 administration interval before 
      surgery, since the risk of postoperative infection appears to be higher if the 
      operation occurs within this period.
CI  - Copyright (c) 2013 by the American College of Rheumatology.
FAU - Scherrer, Catrina B
AU  - Scherrer CB
AD  - Schulthess Clinic Zurich, Zurich, Switzerland.
FAU - Mannion, Anne F
AU  - Mannion AF
FAU - Kyburz, Diego
AU  - Kyburz D
FAU - Vogt, Markus
AU  - Vogt M
FAU - Kramers-de Quervain, Ines A
AU  - Kramers-de Quervain IA
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Arthritis Care Res (Hoboken)
JT  - Arthritis care & research
JID - 101518086
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Aged
MH  - Antirheumatic Agents/*therapeutic use
MH  - Female
MH  - Humans
MH  - *Immunocompromised Host
MH  - Immunosuppressive Agents/*adverse effects
MH  - Infections/*etiology
MH  - Male
MH  - Middle Aged
MH  - Orthopedic Procedures/adverse effects
MH  - Postoperative Complications/epidemiology/*immunology
MH  - Rheumatic Diseases/drug therapy/*surgery
MH  - Risk Factors
EDAT- 2013/07/19 06:00
MHDA- 2014/01/24 06:00
CRDT- 2013/07/18 06:00
PHST- 2012/12/18 00:00 [received]
PHST- 2013/07/04 00:00 [accepted]
PHST- 2013/07/18 06:00 [entrez]
PHST- 2013/07/19 06:00 [pubmed]
PHST- 2014/01/24 06:00 [medline]
AID - 10.1002/acr.22077 [doi]
PST - ppublish
SO  - Arthritis Care Res (Hoboken). 2013 Dec;65(12):2032-40. doi: 10.1002/acr.22077.