RESEARCH - Effects of perioperative antiinflammatory and immunomodulating therapy on surgical wound healing

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Pharmacotherapy. 2005 Nov;25(11):1566-91.

Effects of perioperative antiinflammatory and immunomodulating therapy on

surgical wound healing.

Texas Tech University Health Sciences Center School of Pharmacy, Dallas-Ft.

Worth Regional Campus, Dallas, Texas 75216, USA. anthony.busti@...

Patients with various rheumatologic and inflammatory disease states commonly

require drugs known to decrease the inflammatory or autoimmune response for

adequate control of their condition. Such drugs include nonsteroidal

antiinflammatory drugs (NSAIDs), cyclooxygenase (COX)-2 inhibitors,

corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and

biologic response modifiers. These drugs affect inflammation and local

immune responses, which are necessary for proper wound healing in the

perioperative setting, thereby potentially resulting in undesirable

postoperative complications. Such complications include wound dehiscence,

infection, and impaired collagen synthesis. The end result is delayed

healing of soft tissue and bone wounds. The current literature provides

insight into the effect of some of these drugs on wound healing. For certain

drugs, such as methotrexate, trials have been conducted in humans and direct

us on what to do during the perioperative period. Whereas with other drugs,

we must rely on either small-animal studies or extrapolation of data from

human studies that did not specifically look at wound healing.

Unfortunately, no clear consensus exists on the need and optimum time for

withholding therapy before surgery. Likewise, clinicians are often uncertain

of the appropriate time to resume therapy after the procedure. For those

drugs with limited or no data in this setting, the use of pharmacokinetic

properties and biologic effects of each drug should be considered

individually. In some cases, discontinuation of therapy may be required up

to 4 weeks before surgery because of the long half-lives of the drugs. In

doing so, patients may experience an exacerbation or worsening of disease.

Clinicians must carefully evaluate individual patient risk factors, disease

severity, and the pharmacokinetics of available therapies when weighing the

risks and benefits of discontinuing therapy in the perioperative setting.

PMID: 16232020

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16232020

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