Registry Evaluation of Digital Ulcers in Systemic Sclerosis

Galluccio, Felice; Matucci‐Cerinic, Marco

doi:10.1155/2010/363679

Cited by 9 publications

(4 citation statements)

References 19 publications

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“…In the interest of having uniform patient populations and increasing the probability of obtaining a clear answer, strong consideration should be given to disease duration [8], to the time from onset of the first DU [9] and the capillaroscopic pattern (early, active or late) [40]. In a trial studying DUs, capillaroscopic patterns can be studied as a substudy, but a limitation in using capillaroscopy is the fact that patterns are unlikely to change over a short trial.…”

Section: Inclusion Criteriamentioning

confidence: 99%

Points to consider for skin ulcers in systemic sclerosis

et al. 2017

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This article discusses points to consider when undertaking a clinical trial to test therapy for skin ulcers in SSc. A validated definition of skin ulcers should be used if available. Defining a uniform SSc patient population, including consideration of disease duration, history of digital ulcers and capillaroscopic patterns, is important. Excluding confounding factors such as infection, calcinosis and trauma should be strongly considered, or at least accounted for, in defining patients. Outcome measures such as time to healing, prevention of new ulcers, function, pain and objective measures such as US, laser Doppler and thermography can be considered as outcome measures, although their validation has not yet been achieved and efforts may be needed to validate them before use. Likewise, biomarkers should be considered or consideration should be given to storing serum, plasma or cells for possible future analysis. A pre-planned analysis is important and should include consideration of missing data.

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Section: Inclusion Criteriamentioning

confidence: 99%

Points to consider for skin ulcers in systemic sclerosis

et al. 2017

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“…This significance was predominately contributed by the development of higher rates of 30-day postoperative surgical site infection, urinary tract infection, bloodstream infection or sepsis when compared to controls. SSc patients with skin ulcers secondary to microcirculatory vasculopathy have been perceived to have higher rates of impaired wound healing [26][27][28] . Secondly, all-cause mortality studies in SSc populations have observed that 33% of deaths due to non-SSc-related causes were attributed to infections, particularly septicemia and pneumonia 29 .…”

Section: Discussionmentioning

confidence: 99%

Perioperative Complications in Patients with Systemic Sclerosis: A Comparative Cohort Analysis A Comparative Cohort Analysis

J. Carr

2023

MRAJ

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Background: Systemic sclerosis (SSc) is a rare autoimmune disorder with pathological manifestations affecting multiple organ systems. Few studies have examined perioperative outcomes in patients with this disorder. The primary aim of this retrospective single-center comparative cohort analysis was to estimate the incidence of select perioperative complications in a population of SSc patients. In an exploratory analysis, we analyzed the relationship between SSc and susceptibility to select perioperative complications when treated at a large quaternary-care institution. Methods: We conducted a single-center retrospective, comparative cohort study to compare perioperative outcomes in a SSc (n=258) and a frequency matched control cohort (n=632). We analyzed for the presence of major composite infection (MCI), major adverse cardiac events (MACE), 30-day readmission, 30-day mortality, in-hospital complications, length of stay and airway management outcomes. Results: MCI was higher in the SSc compared to the control cohort [adjusted odds ratio (ORadj)=5.02 (95%CI: 2.47-10.20) p<0.001]. Surgical site infection (3.5% vs. 0%, p<0.001), and other infection types (5% vs. 0%, p<0.001) were higher in the SSc cohort. MACE was not significantly different between SSc vs. Control groups [6.2% vs. 7.9%, ORadj=1.33 (95%CI: 0.61-2.91) p=0.48]. Higher rates of limited cervical range of motion (13.6% vs. 3.5%, p<0.001), microstomia (11.5% vs. 1.3%, p<0.001) and preoperative difficult airway designation (8.7% vs. 0.5%, p<0.001) were observed in the SSc cohort. Bag mask ventilation grade was similar between groups (p=0.44). After adjustment, there was no between-group difference in Cormack-Lehane grade 3 and 4 view on direct laryngoscopy in SSc patients [ORadj = 1.86 (95%CI: 0.612 -5.66) p=0.18] but evidence of higher rates of video laryngoscopy [ORadj= 1.87 (95%CI:1.07 - 3.27) p=0.03]. Length of stay [median: 0.2 vs. 0.3 days, p=0.08], 30-day mortality [1.2% vs. 0.6%, ORadj=2.79 (95%CI: 0.50-15.6) p=0.24] and readmission [11.5% vs. 8.1%, ORadj=1.64 (95%CI: 0.96 – 2.82) p=0.07] were not statistically significant. Conclusions: SSc patients demonstrate mostly similar rates of MACE, 30-day mortality, length of stay intraoperative and airway complications. There is evidence of increased risk of overall 30-day MCI risk and readmission after endoscopic procedures.

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“…Documented postoperative wound infections occurred in 3.8% of procedures in our SSc cohort, comparable to the 2-5% incidence for the general surgical population and we did not observe a difference between lSSc and dSSc 28,29 . This distinction is important, since dSSc patients with skin ulcers secondary to microcirculatory vasculopathy have been perceived to have higher rates of impaired wound healing [30][31][32] .…”

Section: Discussionmentioning

confidence: 99%

Perioperative Outcomes in Patients with Systemic Sclerosis: Analysis of a Large Single- Center Case Series

Carr

Yan

Yanez

et al. 2022

Preprint

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Background There are significant knowledge gaps regarding perioperative outcomes for patients with systemic sclerosis (SSc), a rare immune-mediated disease characterized by cutaneous and organ-based fibrosis. The primary aim of this study was to describe the incidence of various perioperative complications in a single-center population of SSc. Methods 278 SSc patients with 605 unique surgical encounters were identified over a ten-year period (Jan 1, 2010, through Jan 1, 2020). Data collection included airway management, intraoperative adverse events (pulmonary aspiration, cardiac arrest, difficult airway designation), and 30-day postoperative complications (pneumonia, myocardial infarction, atrial fibrillation, congestive heart failure). Results Hypertension (57.9%), pulmonary hypertension (PH) or pulmonary arterial hypertension (PAH) (52.5%), interstitial lung disease (ILD) (32.4%), and gastroesophageal reflux disease (82.4%) were common in our study population. Difficult direct laryngoscopy occurred in 10.9% of cases, but the first attempt success rate was high at 93.2%. Video laryngoscopy was used in 24.1% of cases. The most common intraoperative complications were hypotension and bradycardia within 15 minutes of induction (24.3% and 17.5%, respectively), and vasopressor use (34.0%). The in-hospital complication rate was 14.7% while the 30-day postoperative complication rate was 27.6%, with ileus > 3 days (5.6%) and postoperative pneumonia (POP) (5.5%) occurring most often. Microstomia was an independent predictor of difficult airway designation [Adjusted Odds Ratio (ORadj): 3.42, 95% Confidence Interval (CI) = 1.13, 10.31, p = 0.029]. ILD was not associated with 30-day POP (ORadj: 1.41, 95% CI = 0.54, 3.71, p = 0.482). A composite of PH/PAH was an independent predictor for 30-day POP (ORadj: 2.61, 95% CI = 1.08, 6.29, p = 0.033), 30-day CHF diagnosis (ORadj: 4.15, 95% CI = 1.33, 12.94, p = 0.014), and 30-day mortality (ORadj: 3.57, 95% CI = 1.24, 10.28, p = 0.018). Conclusions This study identified perioperative characteristics of patients with SSc. Current knowledge on perioperative outcomes in SSc in the surgical population is predominately based on reports of single case reports or small case series. Our findings suggest that intraoperative and airway complications are similar but postoperative complications are high when compared to known incidences in surgical populations. Secondly, this study demonstrates that composite PAH/PH but not ILD was a strong predictor of POP, CHF and 30-day mortality in this patient population.

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Registry Evaluation of Digital Ulcers in Systemic Sclerosis

Cited by 9 publications

References 19 publications

Points to consider for skin ulcers in systemic sclerosis

Points to consider for skin ulcers in systemic sclerosis

Perioperative Complications in Patients with Systemic Sclerosis: A Comparative Cohort Analysis A Comparative Cohort Analysis

Perioperative Outcomes in Patients with Systemic Sclerosis: Analysis of a Large Single- Center Case Series

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