Perioperative use of anti-rheumatic agents does not increase early postoperative infection risks: a Veteran Affairs’ administrative database study
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The aim of this study was to validate a novel technique that predicts stopping of disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents (BA) from the Veterans Affairs (VA) database and compare infection risks of rheumatoid arthritis patients who stopped versus continued DMARDs/BA perioperatively. We identified 6,024 patients on 1 DMARD or BA in the perioperative period between 1999 and 2009. Time gap between medication stop date and the next start date predicted drug stoppage (X). Time gap between surgery date and stop date predicted whether stoppage was before surgery (Y). Chart review from Houston VA was used for validation. ROC analyses were performed on chart review data to obtain X and Y cutoffs. The primary endpoints were wound infections and other infections within 30 days. ROC analyses found X ≥ 33 (AUC = 0.954) and Y ≥ −11 (AUC = 0.846). Risk of postoperative infections was not different when stopping and continuing DMARDs/BA preoperatively. Stopping BA after surgery was associated with higher odds of postoperative wound (OR 14.15, 95 % CI 1.76–113.76) and general infection (OR 9.2, 95 % CI 1.99–42.60) compared to not stopping. Stopping DMARDs after surgery was associated with increased risk of postoperative general infection (OR 1.84, 95 % CI 1.07–3.16) compared with not stopping. There was positive association between stopping DMARDs after surgery and postoperative wound infection but failed to achieve statistical significance (OR 1.67, 95 % CI 0.96–2.91). There was no significant difference in postoperative infection risk when stopping or continuing DMARD/BA. Our new validated method can be utilized in the VA and other databases to predict drug stoppage.
KeywordsAnti-TNF drugs Rheumatoid arthritis Disease-modifying anti-rheumatic drugs (DMARD) Infection Surgery
The research reported here was supported by the Department of Veteran Affairs, Veterans Health Administration, Health Services Research and Development Service, (VA.SCV.1010./000-00.B_N). This work was also partly supported by the Veterans Affairs Health Services Research and Development Service Houston Center of Excellence (HFP90-020). Dr. Bernard Ng held a South Central VA Health Care Network Research Pilot Grant Award and was a consultant to UCB Pharmaceuticals. The rest of the authors have no conflicts of interest to declare. The funding sources had no role in the study design, conduct and analysis or in the decision to submit the manuscript for publication.
Conflict of interest
- 1.Listing J, Strangfeld A, Kary S, Rau R, von Hinueber U, Stoyanova-Scholz M, Gromnica-Ihle E, Antoni C, Herzer P, Kekow J, Schneider M, Zink A (2005) Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum 52(11):3403–3412. doi: 10.1002/art.21386 PubMedCrossRefGoogle Scholar
- 7.The Society for Hospital Epidemiology of America, The Association for Practitioners in Infection Control, The Centers for Disease Control, The Surgical Infection Society (1992) Consensus paper on the surveillance of surgical wound infections. Infect Control Hosp Epidemiol 13:599–605CrossRefGoogle Scholar
- 15.den Broeder AA, Creemers MC, Fransen J, de Jong E, de Rooij DJ, Wymenga A, de Waal-Malefijt M, van den Hoogen FH (2007) Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti-tumor necrosis factor: a large retrospective study. J Rheumatol 34(4):689–695Google Scholar
- 16.Kawakami K, Ikari K, Kawamura K, Tsukahara S, Iwamoto T, Yano K, Sakuma Y, Tokita A, Momohara S (2010) Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-alpha blockers: perioperative interruption of tumour necrosis factor-alpha blockers decreases complications? Rheumatology 49(2):341–347PubMedCrossRefGoogle Scholar
- 18.Shergy WJ, Phillips RM, Hunt RE, Hernandez J (2005) Infliximab and its impact on surgical outcomes in patients with rheumatoid arthritis. EULAR Meet Abstr 64(Suppl 3):1511Google Scholar