Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
J Hand Surg Am. 2020 Aug;45(8):779.e1-779.e6. doi: 10.1016/j.jhsa.2020.02.005. Epub 2020 Mar 21.
Rheumatoid arthritis (RA) is a destructive inflammatory disease that commonly involves joints of the hand and wrist. Different recommendations exist for continuing or discontinuing immunosuppressant medications during the perioperative time period. The purpose of our study was to determine whether continuing or discontinuing medications (steroids, nonbiological, and/or biological disease-modifying antirheumatic drugs [DMARDs]) were associated with an increased or decreased risk of postoperative complications.
We performed a single-center, retrospective review of a cohort of RA patients who had elective hand surgery by a single surgeon. Patients were included if they had a documented diagnosis of seropositive RA by a rheumatologist and had elective hand surgery and/or a disease-related surgical procedure involving the upper extremity between January 2008 and August 2018. We stratified patients into different groups for comparison by classes of immunosuppressant medications for managing RA. These classes included corticosteroids, nonbiological DMARDs, biological DMARDs, and/or no medications. Immunosuppressant medications were then compared with no medications for the incidence of postoperative overall complications.
Eighty-eight patients had elective hand and/or upper extremity surgeries for RA. Mean patient age at the time of surgery (± SD) was 55 ± 13 years (range, 24-74 years). Of these 88 patients, 8 (9%) overall complications occurred. Complications were wound healing failures (n = 5), tendon rupture (n = 1), hematoma (n = 1), and surgical-site infection (n = 1). Perioperative medications included steroids (n = 31), nonbiological DMARDs (n = 68), biological DMARDs (n = 5), and no medication (n = 27). There were no significant differences in overall complications between patients on immunosuppressant medications and those on no medications. Median (interquartile range) follow-up was 11.5 months (5-25.8) (range, 2-74 months).
We found that patients who continued or discontinued medications within 1 dosing interval of their usual dose perioperatively had similar rates of complications following elective hand surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
类风湿关节炎（RA）是一种破坏性炎症性疾病，通常累及手部和腕部关节。对于围手术期继续或停止使用免疫抑制剂药物存在不同的建议。本研究的目的是确定继续或停止使用药物（类固醇、非生物和/或生物改善病情抗风湿药物[DMARDs]）是否与术后并发症的风险增加或降低相关。
我们对 2008 年 1 月至 2018 年 8 月间由同一位外科医生进行的手部择期手术的 RA 患者进行了单中心回顾性队列研究。如果患者由风湿病专家确诊为血清阳性 RA，并且接受了手部择期手术和/或涉及上肢的与疾病相关的手术，则将其纳入研究。我们根据用于治疗 RA 的免疫抑制剂药物类别将患者分为不同的组进行比较。这些类别包括皮质类固醇、非生物 DMARDs、生物 DMARDs 和/或无药物治疗。然后比较免疫抑制剂药物与无药物治疗的术后总体并发症发生率。
88 例患者因 RA 行手部和/或上肢择期手术。手术时患者的平均年龄（±标准差）为 55 ± 13 岁（范围，24-74 岁）。88 例患者中，共有 8 例（9%）发生总体并发症。并发症包括伤口愈合失败（n=5）、肌腱断裂（n=1）、血肿（n=1）和手术部位感染（n=1）。围手术期药物包括皮质类固醇（n=31）、非生物 DMARDs（n=68）、生物 DMARDs（n=5）和无药物治疗（n=27）。在使用免疫抑制剂药物和未使用药物的患者之间，总体并发症发生率无显著差异。中位（四分位距）随访时间为 11.5 个月（5-25.8）（范围，2-74 个月）。
我们发现，在围手术期内继续或停止使用药物的患者，在接受手部择期手术后的并发症发生率相似。
研究类型/证据水平：治疗性 IV 级。
