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Perioperative Antirheumatic Drug Use Does Not Impact Postsurgery Infection Rate in RA Patients

Key clinical point: A higher Charlson Comorbidity Index and longer surgery time, rather than preop antirheumatic medications, increased risk of postop infection in patients with seropositive RA.

Major finding: Higher Charlson Comorbidity Index predicted infection risk, with an odds ratio of 1.37 per 1-point increase in the index (95% confidence interval, 1.10-1.70). Length of surgery also increased the risk of infection, with an OR of 1.16 per 15-minute increase in surgery time (95% CI, 1.09-1.23).

Study details: A retrospective cohort study of 154 RA patients who underwent either musculoskeletal or major organ surgery.

Disclosures: This study was funded by the University of Minnesota. Dr. Shmagel reported no relevant conflicts of interest.

Citation:

Kerski M et al. Arthritis Rheumatol. 2019;71 (suppl 10), Abstract 1805.

Commentary:

This study, presented at the ACR annual meeting in 2019, re-examined the controversial topic of infectious risk related to RA treatment in patients undergoing surgery. Of 244 surgeries at a single center—165 of which were “musculoskeletal”—116 were performed in patients not receiving medication at the time of surgery, 95 in patients being treated with DMARDs, and 32 in patients undergoing biologics treatment with or without DMARDs. Rates of infection, including surgical site, UTI, pneumonia, and bloodstream infections, were similar in all three groups. Other predictors of infection were examined, and the authors reported that a higher Charlson comorbidity index and longer surgery duration were associated with an increased risk forf infection; while these were significant, the study did not report the odds ratios for these groups. Because the patients not on medication had varying treatment (some patients not receiving any and others with medication held for a period of time not specified in the study), it is hard to generalize this finding. However, it lends further support for the idea that continuation of RA therapy perioperatively is not necessarily a determinant of adverse surgical outcome in terms of risk for infection. The risk of perioperative flare should also be considered in RA patients prior to surgery.— Arundathi Jayatilleke, MD