Latourte Augustin, Gottenberg Jacques-Eric, Luxembourger Cécile, Pane Isabelle, Claudepierre Pascal, Richette Pascal, Lafforgue Pierre, Combe Bernard, Cantagrel Alain, Sibilia Jean, Flipo René-Marc, Gaudin Philippe, Vittecoq Olivier, Schaeverbeke Thierry, Dougados Maxime, Sellam Jeremie, Ravaud Philippe, Mariette Xavier, Seror Raphaèle
Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre.
Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris.
Rheumatology (Oxford). 2017 Apr 1;56(4):629-637. doi: 10.1093/rheumatology/kew476.
To investigate the frequency and risk factors of postoperative complications in RA patients treated with abatacept (ABA).
The Orencia RA registry recruited 1012 patients receiving ABA for RA in routine care. Data from patients treated with ABA who underwent surgery were reviewed to describe the frequency of postoperative complications. Characteristics of patients and surgeries with and without complications were compared to identify factors associated with complications.
We identified 205 (20.3%) patients who underwent 263 surgeries, including 176 (66.9%) orthopaedic surgeries. Nineteen (7.2%) surgeries, in 19 patients (9.3%), entailed complications, including 7 delayed wound healing (2.7% of surgeries) and 6 surgical site infections (2.3% of surgeries). The median time between the last infusion of ABA and surgery was 5.9 weeks (range: 0.3-12.0 weeks), with no significant difference between patients with and without complications. The median corticosteroids daily dosage was higher in the group with complications [10.0 (6.25-15.0) vs 6.0 (5.0-10.0) mg/day, P = 0.042]. In multivariate analysis, only the duration of ABA treatment was significantly associated with postoperative complications [adjusted odds ratio (aOR) = 0.94 (95% CI: 0.89, 0.99) for each month of treatment], as were orthopaedic surgeries compared with other kinds of surgery [aOR = 4.45 (95% CI: 1.01, 20.2)].
In RA patients treated with ABA, the rate of surgical complications was low: 7.2% and higher in case of orthopaedic procedure and a more recent initiation of ABA. The median time between surgery and the last infusion of ABA was short and did not influence the rate of postoperative complications.
探讨接受阿巴西普（ABA）治疗的类风湿关节炎（RA）患者术后并发症的发生率及危险因素。
奥瑞珠单抗RA注册研究纳入了1012例在常规治疗中接受ABA治疗的RA患者。回顾接受ABA治疗且接受手术患者的数据，以描述术后并发症的发生率。比较有并发症和无并发症患者及手术的特征，以确定与并发症相关的因素。
我们确定了205例（20.3%）接受263次手术的患者，其中包括176例（66.9%）骨科手术。19例患者（9.3%）的19次手术（7.2%）出现并发症，包括7例伤口愈合延迟（占手术的2.7%）和6例手术部位感染（占手术的2.3%）。末次输注ABA至手术的中位时间为5.9周（范围：0.3 - 12.0周），有并发症和无并发症患者之间无显著差异。并发症组的皮质类固醇每日中位剂量更高[10.0（6.25 - 15.0）mg/天 vs 6.0（5.0 - 10.0）mg/天，P = 0.042]。多因素分析显示，仅ABA治疗持续时间与术后并发症显著相关[每治疗1个月的调整优势比（aOR）= 0.94（95%CI：0.89，0.99）]，与其他类型手术相比，骨科手术也与术后并发症相关[aOR = 4.45（95%CI：1.01，20.2）]。
在接受ABA治疗的RA患者中，手术并发症发生率较低：为7.2%，骨科手术及近期开始使用ABA的情况下发生率更高。手术与末次输注ABA之间的中位时间较短，且不影响术后并发症发生率。
