Rheumatoid arthritis patients are not at increased risk for 30-day cardiovascular events, infections, or mortality after total joint arthroplastyReportar como inadecuado




Rheumatoid arthritis patients are not at increased risk for 30-day cardiovascular events, infections, or mortality after total joint arthroplasty - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Arthritis Research and Therapy

, 15:R195

First Online: 20 November 2013Received: 10 May 2013Accepted: 07 November 2013

Abstract

IntroductionSerious infection, cardiovascular disease, and mortality are increased in rheumatoid arthritis RA. Whether RA affects the risk for these complications after total joint arthroplasty TJA is unknown, we hypothesize that it does. We compared the occurrence of 30-day postoperative complications and mortality in a large cohort of RA and osteoarthritis OA patients undergoing hip or knee TJA.

MethodsAnalyses included 7-year data from the Veterans Affairs Surgical Quality Improvement Program. The 30-day complications were compared by diagnosis by using logistic regression, and long-term mortality was examined by using Cox proportional hazards regression. All analyses were adjusted for age, sex, and clustering by surgical site. Additional covariates included sociodemographics, comorbidities, health behaviors, and operative risk factors.

ResultsThe 34,524 patients 839 RA, 33,685 OA underwent knee 65.9% or hip TJA. Patients were 95.7% men with a mean SD age of 64.4 10.7 years and had 3,764 deaths over a mean follow-up of 3.7 2.3 years. Compared with OA patients, those with RA were significantly more likely to require a return to the operating room odds ratio OR, 1.45 95% CI, 1.08 to 1.94, but had similar rates of 30-day postoperative infection, OR 1.02 0.72 to 1.47, cardiovascular events, OR 0.69 0.37 to 1.28, and mortality, OR 0.94 0.38 to 2.33. RA was associated with a significantly higher long-term mortality; hazard ratio HR, 1.22 1.00 to 1.49.

ConclusionIn this study of US veterans, RA patients were not at an increased risk for short-term mortality or other major complications after TJA, although they returned to the operating room more often and had increased long-term mortality.

AbbreviationsASAAmerican Society of Anesthesiologists

BIRLSBeneficiary Identification of Records Locator System

CHFCongestive heart failure

COPDChronic obstructive pulmonary disease

CPRCardiopulmonary resuscitation

CPTCurrent procedural terminology

CVCardiovascular

CVACerebrovascular accident

DMARDDisease-modifying antirheumatic drug

GCSGlucocorticosteroid

HRHazard ratio

ICD9International Statistical Classification of Disease and Related Health Problems, Ninth Revision

OAOsteoarthritis

OROdds ratio

PBMPharmacy Benefits Management

POPostoperative

RARheumatoid arthritis

SDStandard deviation

SGOTSerum glutamic oxaloacetic transaminase

THATotal hip arthroplasty

TIATransient ischemic attack

TJATotal joint arthroplasty

TKATotal knee arthroplasty

VAVeterans Affairs

VASQIPVeterans Affairs Surgical Quality Improvement Program.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4385 contains supplementary material, which is available to authorized users.

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Autor: Kaleb Michaud - Edward V Fehringer - Kevin Garvin - James R O’Dell - Ted R Mikuls

Fuente: https://link.springer.com/



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