Risk Factor Analysis of Perioperative Complications in Patients with Rheumatoid Arthritis Undergoing Primary Cervical Spine Surgery

Abstract

Background: Rheumatoid arthritis (RA) often causes cervical spine lesions as the disease condition progresses, which induce occipital neuralgia or cervical myelopathy requiring surgical interventions. Meanwhile, patients with RA are susceptible to infection or other complications in the perioperative period because they frequently have comorbidities and use immunosuppressive medications. However, the risk factors or characteristics of patients with RA who experience perioperative complications after cervical spine surgery remain unknown. A risk factor analysis of perioperative complications in patients with RA who underwent primary cervical spine surgery was conducted in the present study.Methods: A total of 139 patients with RA who underwent primary cervical spine surgery from January 2001 to March 2020 were retrospectively investigated. Age and height, weight, serum albumin, serum C-reactive protein, American Society of Anesthesiologists Physical Status (ASA-PS), Charlson comorbidity index, medications used, cervical spine lesion, surgery time, bleeding volume, and procedures were collected from medical records to compare the patients with complications to those without complications after surgery. The risk factors for perioperative complications were assessed by univariate and multivariate logistic regression analysis.Results: Twenty-eight patients (20.1%) had perioperative complications. Perioperative complications were significantly associated with the following factors [data presented as odds ratio (confidence interval)]: lower height [0.928 (0.880-0.980), p=0.007], higher ASA-PS [2.296 (1.007-5.235), p=0.048], longer operation time [1.013 (1.004-1.021), p=0.003], more bleeding volume [1.004 (1.000-1.007), p=0.04], higher rates of vertical subluxation [2.914 (1.229-6.911), p=0.015] and subaxial subluxation (SAS) [2.507 (1.063-5.913), p=0.036], occipito-cervical (OC) fusion [3.438 (1.189-9.934), p=0.023], and occipito-cervical/thoracic (long) fusion [8.021 (2.145-29.99), p=0.002] in univariate analyses. In multivariate analyses, lower height [0.915 (0.860-0.974), p=0.005], higher ASA-PS [2.622 (1.023-6.717), p=0.045] and long fusion [7.289 (1.694-31.36), p=0.008] remained risk factors. High-dose prednisolone use [1.247 (1.024-1.519), p=0.028], SAS [6.413 (1.381-29.79), p=0.018], OC fusion [17.93 (1.242-258.8), p=0.034] and long fusion [108.1 (6.876-1699), p<0.001] were associated with severe complications.Conclusions: ASA-PS and long fusion could be indicators predicting perioperative complications in patients with RA after cervical spine surgery. In addition, cervical spine lesions requiring OC fusion or long fusion and high-dose prednisolone use were suggested to be risk factors for increasing severe complications.

Risk factors for ninety-day readmission following cervical surgery: a meta-analysis

“…In patients with higher ASA classification, these drugs used during anesthesia disturb the balance state of the patients' physiology. When undergoing cervical surgery, the ability of human body to maintain physiological homeostasis is under tremendous pressure, and the physical difficulties faced by elderly patients are more arduous [24,25]. Our analysis suggested that ASA class was not significantly correlated to the ninety-day readmission rate.…”

Artritis reumatoide de la columna cervical: Aspectos clave para el cirujano ortopédico

“…Se ha demostrado que los pacientes con AR tienen mayor prevalencia de comorbilidades e incidencia de complicaciones que los pacientes sin AR en cirugía de columna “no cervical” primaria. 57 En un análisis de factores de riesgo, 58 se detectó un 20% de complicaciones en 139 pacientes con AR operados de la columna cervical, y se determinó que los factores de riesgo para complicaciones mayores fueron uso de prednisolona en dosis altas, diagnóstico de subluxación subaxial, artrodesis occipitocervical, y artrodesis larga. El 40% de las complicaciones fueron infecciones y, la mitad de ellas, de herida operatoria.…”

“…El 40% de las complicaciones fueron infecciones y, la mitad de ellas, de herida operatoria. 58 Sin embargo, en otro estudio, 57 no se encontró relación entre las infecciones y el uso de prednisolona, metrotrexato, agentes biológicos, ni inhibidores JAK.…”

“…Patients with RA have a higher prevalence of comorbidities and incidence rate of complications than patients without RA in primary “non-cervical” spine surgery. 57 A risk factor analysis detected 20% of complications in 139 RA patients submitted to cervical spine surgery. The risk factors for major complications included the use of high doses of prednisolone, diagnosis of subaxial subluxation, occipitocervical arthrodesis, and long arthrodesis.…”

“…A total of 40% of the complications were infections, and half of them were in surgical wounds. 58 However, another study 57 found no relationship between infections and treatment with prednisolone, methotrexate, biological agents, or JAK inhibitors.…”