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Systemic Lupus Erythematosus

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Perioperative Management of Patients with Rheumatic Disease

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Abstract

Directing the care of patients with systemic lupus erythematosus (SLE) during the perioperative period may be no less challenging than managing their disease during the nonoperative period. While the team can prepare a patient for elective surgery, it is the unexpected emergency procedures and the unforeseen postoperative complications that pose the most difficulties.

In a study of surgical outcomes in patients with SLE, Papa et al. described 29 patients with SLE who underwent a total of 36 surgical procedures (1). At the time of surgical intervention, 19 patients had active SLE. In this study, 37 complications occurred. Wound complications, such as persistent drainage and the development of fistulae accounted for 24% of the adverse events, followed by respiratory (16%) and infectious (16%) complications. Infectious complications, including abscess formation and sepsis, as well as respiratory complications, such as acute respiratory distress syndrome, pneumothorax, pleural effusion, and prolonged intubation time, were reported. Patients experiencing complications had higher oral prednisone doses, higher number of organ systems involved, and more frequent renal involvement than those who did not develop complications. In a study assessing the risk factors for operative morbidity in patients with SLE by Takahashi et al., 53 patients underwent 63 surgical procedures (2). Postoperative complications were seen in 15.8%, and four patients expired. Most of the surgical complications in this study were infectious. Some of the preoperative ­variables that correlated with the presence of operative morbidity were identified. Upon ­univariate analysis, lymphopenia and hypoalbuminemia were significantly correlated and also were associated with higher surgical ­morbidity. After multivariate logistic regression analysis, physical status, urgent indication, and blood urea nitrogen were risk factors for operative morbidity.

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Authors and Affiliations

  1. Division of Rheumatology, North Shore University Hospital, 2800 Marcus Avenue, Ste. 200, Lake Success, NY, 11042, USA

    Richard A. Furie M.D.

  2. Division of Rheumatology and Allergy-Clinical Immunology, North Shore – LIJ Health System, 2800 Marcus Avenue, Lake Success, NY, 11030, USA

    Elena Katzap D.O.

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  1. Elena Katzap D.O.
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Correspondence to Richard A. Furie M.D. .

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Editors and Affiliations

  1. Department of Rheumatologic, and Immunologic Disease, Cleveland Clinic, Euclid Avenue 9500, Cleveland, 44195, Ohio, USA

    Brian F. Mandell

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Katzap, E., Furie, R.A. (2013). Systemic Lupus Erythematosus. In: Mandell, B. (eds) Perioperative Management of Patients with Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2203-7_14

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  • DOI: https://doi.org/10.1007/978-1-4614-2203-7_14

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