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Delayed wound healing and postoperative surgical site infections in patients with rheumatoid arthritis treated with or without biological disease-modifying antirheumatic drugs

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Abstract

Biological disease-modifying antirheumatic drugs (bDMARDs) have become more popular for treating rheumatoid arthritis (RA). Whether or not bDMARDs increase the postoperative risk of surgical site infection (SSI) has remained controversial. We aimed to clarify the effects of bDMARDs on the outcomes of elective orthopedic surgery. We used multivariate logistic regression analysis to analyze risk factors for SSI and delayed wound healing among 227 patients with RA (mean age, 65.0 years; disease duration, 16.9 years) after 332 elective orthopedic surgeries. We also attempted to evaluate the effects of individual medications on infection. Rates of bDMARD and conventional synthetic DMARD (csDMARD) administration were 30.4 and 91.0 %, respectively. Risk factors for SSI were advanced age (odds ratio [OR], 1.11; P = 0.045), prolonged surgery (OR, 1.02; P = 0.03), and preoperative white blood cell count >10,000/μL (OR, 3.66; P = 0.003). Those for delayed wound healing were advanced age (OR, 1.16; P = 0.001), prolonged surgery (OR, 1.02; P = 0.007), preoperative white blood cell count >10,000/μL (OR, 4.56; P = 0.02), and foot surgery (OR, 6.60; P = 0.001). Risk factors for SSI and medications did not significantly differ. No DMARDs were risk factors for any outcome examined. Biological DMARDs were not risk factors for postoperative SSI. Foot surgery was a risk factor for delayed wound healing.

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Acknowledgments

We thank Atsuko Kamiyama and Tomoko Nakatsuka for coordinating the study and managing the quality of the data.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan

    Masahiro Tada & Noriaki Hidaka

  2. Department of Rheumatosurgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Kentaro Inui

  3. Center for Senile Degenerative Disorders (CSDD), Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Yuko Sugioka & Tatsuya Koike

  4. Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Kenji Mamoto, Tadashi Okano & Takuya Kinoshita

  5. Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, Nishimurogun Shirahamacho 1447, Wakayama, 649-2211, Japan

    Tatsuya Koike

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  1. Masahiro Tada
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Correspondence to Tatsuya Koike.

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Contributors

Study design: MT and TK. Study implementation: TK. Data collection: TO, YS, TK, NH, and KM. Data analysis: MT and TK. Data interpretation: MT, TK, and KI. Drafting the manuscript: MT, TK, and KI. Approving the final version of the manuscript: all.

Conflict of Interest

Koike has received grant, research, and consulting fees, as well as other remuneration from AbbVie, Astellas Pharma Inc., Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB. Tada, Inui, Sugioka, Mamoto, Okano, Kinoshita, and Hidaka have no conflicts of interest to declare.

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Tada, M., Inui, K., Sugioka, Y. et al. Delayed wound healing and postoperative surgical site infections in patients with rheumatoid arthritis treated with or without biological disease-modifying antirheumatic drugs. Clin Rheumatol 35, 1475–1481 (2016). https://doi.org/10.1007/s10067-016-3274-1

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