Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers

Cordtz, René; Zobbe, Kristian; Højgaard, Pil; Kristensen, Lars Erik; Overgaard, Søren; Odgaard, Anders; Lindegaard, Hanne; Dreyer, Lene

doi:10.1136/annrheumdis-2017-212339

Cited by 98 publications

(75 citation statements)

References 40 publications

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“…Perioperative immunosuppression management has been studied primarily in patients with RA undergoing arthroplasty. Patients with RA are at higher risk of postoperative infections after arthroplasty, with disease activity, comorbidities and immunosuppression all potentially contributing 1–5. Conventional disease-modifying antirheumatic drugs (csDMARDs) such as methotrexate have not been associated with increased postoperative risk 6.…”

Section: Introductionmentioning

confidence: 99%

“…The risk with biological therapies remains uncertain, although studies have suggested that stopping a biologic before arthroplasty does not reduce infection risk and have shown no differences in risk across different biologics 7–9. Several studies, however, have demonstrated increased infection risk and readmission after arthroplasty with even modest glucocorticoid doses 1 4 10–12…”

Section: Introductionmentioning

confidence: 99%

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Immunosuppression and the risk of readmission and mortality in patients with rheumatoid arthritis undergoing hip fracture, abdominopelvic and cardiac surgery

et al. 2020

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ObjectivesThe impact of immunosuppression on postoperative outcomes has primarily been studied in patients undergoing joint replacement surgery. We aimed to evaluate the impact of biologics and glucocorticoids on outcomes after other major surgeries.MethodsThis retrospective cohort study used Medicare data 2006–2015 to identified adults with rheumatoid arthritis undergoing hip fracture repair, abdominopelvic surgery (cholecystectomy, hysterectomy, hernia, appendectomy, colectomy) or cardiac surgery (coronary artery bypass graft, mitral/aortic valve). Logistic regression with propensity-score-based inverse probability weighting compared 90-day mortality and 30-day readmission in patients receiving methotrexate (without a biologic or targeted synthetic disease-modifying antirheumatic drug (tsDMARD)), a tumour necrosis factor inhibitor (TNFi) or a non-TNFi biologic/tsDMARD <8 weeks before surgery. Similar analyses evaluated associations between glucocorticoids and outcomes.ResultsWe identified 10 777 eligible surgeries: 3585 hip fracture, 5025 abdominopelvic and 2167 cardiac surgeries. Compared with patients receiving methotrexate, there was no increase in the risk of 90-day mortality or 30-day readmission among patients receiving a TNFi (mortality adjusted OR (aOR) 0.83 (0.67 to 1.02), readmission aOR 0.86 (0.75 to 0.993)) or non-TNFi biologic/tsDMARD (mortality aOR 0.78 (0.49 to 1.22), readmission aOR 1.02 (0.78 to 1.33)). Analyses stratified by surgery category were similar. Risk of mortality and readmission was higher with 5–10 mg/day of glucocorticoids (mortality aOR 1.41 (1.08 to 1.82), readmission aOR 1.26 (1.05 to 1.52)) or >10 mg/day (mortality aOR 1.64 (1.02 to 2.64), readmission aOR 1.60 (1.15 to 2.24)) versus no glucocorticoids, although results varied when stratifying by surgery category.ConclusionsRecent biologic or tsDMARD use was not associated with a greater risk of mortality or readmission after hip fracture, abdominopelvic or cardiac surgery compared with methotrexate. Higher dose glucocorticoids were associated with greater risk.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immunosuppression and the risk of readmission and mortality in patients with rheumatoid arthritis undergoing hip fracture, abdominopelvic and cardiac surgery

et al. 2020

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“…The mean age at onset PsA in our cohort is at the beginning of the fifth decade and there is a risk that surgical rates may be influenced by age-related osteoarthritis but the high rate of surgery in PsA compared with GPC as presented in this study is still staggering even though the indication is osteoarthritis or erosive joint damage. The mean age for TKA and THA surgery with osteoarthritis as the indication is in Denmark 69 years,29 which is at the end of the sixth decade and in this context the PsA cohort in our study have a higher cumulative risk of surgery at a younger age. Because of the nature of observational studies, we cannot ascertain whether our results reflect changes in referral patterns, a shift in diagnostic focus, for example, the introduction of the CASPAR criteria.…”

Section: Discussionmentioning

confidence: 66%

Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark

et al. 2019

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ObjectiveTo investigate time-trends and cumulative incidence of joint surgery among patients with psoriatic arthritis (PsA) compared with the general population.MethodsIn this nationwide register-based cohort study, The Danish National Patient Registry was used to identify incident PsA patients. The 5-year incidence rates (IR) and incidence rate ratios (IRR) of joint surgery were calculated in four calendar-period defined cohorts. Each patient was matched with ten non-PsA individuals from the general population cohort (GPC). The cumulative incidences of any joint and joint-sacrificing surgery, respectively, were estimated using the Aalen-Johansen method.ResultsFrom 1996 to 2017, 11 960 PsA patients (mean age 50 years; 57% female) were registered. The IRR of any joint surgery was twice as high for PsA patients compared with GPCs across all calendar periods. Among patients with PsA, 2, 10 and 29% required joint surgery at 5, 10 and 15 years after diagnosis. The risk of surgery in PsA patients diagnosed at 18–40 years was higher (22%) than in GPC 60+ year old (20%) after 15 years of follow-up.ConclusionsThe use of joint surgery among PsA patients remained around twofold higher from 1996 to 2012 compared with GPC. After 15 years of follow-up, nearly 30% of the PsA patients had received any surgery, and even a person diagnosed with PsA at the age of 18–40 years had a higher risk of surgery than GPCs of 60+ year old. Thus, the high surgical rates represent an unmet need in the current treatment of PsA.

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“…for TKA performed 2006-2011 (41). Most patients in SKAR have osteoarthritis, and patients with RA have previously been shown to have a increased risk for PJI compared to patients with osteoarthritis(42,43).…”

Section: Discussionmentioning

confidence: 99%

Anti-rheumatic treatment and prosthetic joint infection: An observational study in 494 elective hip and knee arthroplasties.

Borgas

Gülfe

Kindt

et al. 2019

Preprint

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Abstract Background Surgical site infections are more frequent among patients with rheumatic disease. To which extent this is related to immunosuppressive antirheumatic drugs is unclear, as is the value of discontinuing medication perioperatively.Objectives To assess the rate of surgical site infections after knee and hip-replacement in patients with inflammatory joint disease, with emphasis on periprosthetic joint infection, and to investigate the importance of medical treatment in this regard.Methods Data was collected from 494 primary elective hip- (51.4%) and knee arthroplasties along with demographic and medication data and primary outcome was surgical site infections during the first year after surgery.Results In 78% (n=385) of the cases the patient medicated with 1 to 3 disease-modifying antirheumatic drugs perioperatively. Thirty two per cent (n=157) of patients were on a TNF-alpha inhibitor perioperatively. The rate of surgical site infections was 3.8% (n=19) The rate of periprosthetic joint infection was 1.4% (n=7), all of which were knee arthroplasties. Only in 1 case of periprosthetic joint infection the patient medicated perioperatively with a TNF-alpha inhibitor.Conclusion Surgical site infections was not associated with ongoing medication with disease-modifying antirheumatic drugs. Due to low event rate this should be interpreted with caution. Routines at our centre, not stopping biologic disease-modifying antirheumatic drugs perioperatively, will be unchanged.

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Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers

Cited by 98 publications

References 40 publications

Immunosuppression and the risk of readmission and mortality in patients with rheumatoid arthritis undergoing hip fracture, abdominopelvic and cardiac surgery

Immunosuppression and the risk of readmission and mortality in patients with rheumatoid arthritis undergoing hip fracture, abdominopelvic and cardiac surgery

Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark

Anti-rheumatic treatment and prosthetic joint infection: An observational study in 494 elective hip and knee arthroplasties.

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