RESEARCH - Risk factors for surgical site infections and other complications in elective surgery in patients with RA

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J Rheumatol. 2006 Nov 15; [Epub ahead of print]

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.

den Broeder AA, Creemers MC, Fransen J, de Jong E, de Rooij DJ, Wymenga A,

de Waal-Malefijt M, van den Hoogen FH.

From the Department of Rheumatology and Orthopaedic Surgery, Sint

Maartenskliniek; and Department of Rheumatology and Orthopaedic Surgery,

Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

OBJECTIVE: To identify risk factors for surgical site infection (SSI) in

patients with rheumatoid arthritis (RA) with special attention for

anti-tumor necrosis factor (anti-TNF) treatment. METHODS: All patients with

RA who had undergone elective orthopedic surgery since introduction of

anti-TNF were included in a retrospective parallel-cohort study with a

one-year followup. Primary endpoint was a SSI according to the 1992 Centers

for Disease Control and Prevention criteria and/or antibiotic use. Cohort 1

did not use anti-TNF, cohort 2 used anti-TNF but had either stopped (2A) or

continued anti-TNF preoperatively (2B), the cutoff point being set at 4

times the half-life time of the drug. Infection rates were compared between

cohorts, and logistic regression analysis was performed to examine risk

factors. RESULTS: In total, 1219 (768 patients) procedures were included,

and crude infection risks were 4.0% (41/1023), 5.8% (6/104), and 8.7% (8/92)

in cohorts 1, 2A, and 2B, respectively. Elbow surgery (OR 4.1, 95% CI

1.6-10.1), foot/ankle surgery (OR 3.2, 95% CI 1.6-6.5), and prior skin or

wound infection (OR 13.8, 95% CI 5.2-36.7) were associated with increased

risk of SSI, whereas duration of surgery (OR 0.42, 95% CI 0.23-0.78) and

sulfasalazine use (OR 0.21, 95% CI 0.05-0.89) were associated with decreased

risk. Perioperative use of anti-TNF was not significantly associated with an

increase in SSI rates (OR 1.5, 95% CI 0.43-5.2).

CONCLUSION: The most important risk factor for SSI is history of SSI or skin

infection. Although our study was not powered to detect small differences in

infection rates, perioperative continuation of anti-TNF does not seem to be

an important risk factor for SSI.

PMID: 17117492

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

7117492

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