National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.
Rheumatology (Oxford). 2020 Dec 1;59(12):3917-3926. doi: 10.1093/rheumatology/keaa291.
Withholding TNF inhibitors (TNFI) before surgery has been recommended due to concern for post-operative infection. We examined the risks of post-operative infections and mortality in patients with RA in relation to the pre-operative timing of infliximab infusion.
In this population-based retrospective cohort study, we used US Medicare claims data from 2007 to 2015 to identify patients with RA who underwent coronary artery bypass grafting (CABG), aortic or vascular surgery, or bowel resection, and who were treated with infliximab in the 90 days prior to surgery. We examined associations between the timing of infusion and infections and mortality in the 30 days after surgery. We adjusted for the predicted probability of post-operative infection or death, demographic characteristics, use of MTX, post-operative blood transfusion and hospital volume.
We studied 712 patients with CABG, 244 patients with vascular surgery and 862 patients with bowel resections. Post-operative pneumonia occurred in 7.4-11.9%, urinary tract infection in 9.0-15.2%, surgical site infection in 3.2-18.9%, sepsis in 4.2-9.6% and death in 3.5-7.0% among surgery cohorts. There was no association between the time from last infliximab dose to surgery and the risk of post-operative infection or mortality in any surgical cohort. No subgroups were identified that had an increased risk of infection with more proximate use of infliximab.
Among elderly patients with RA, risks of infection and mortality after major surgery were not related to the pre-operative timing of infliximab infusion.
由于担心术后感染，建议在手术前停用 TNF 抑制剂（TNFI）。我们研究了 RA 患者在手术前使用英夫利昔单抗输注的时间与术后感染和死亡率之间的关系。
在这项基于人群的回顾性队列研究中，我们使用了美国医疗保险索赔数据（2007 年至 2015 年），以确定接受冠状动脉旁路移植术（CABG）、主动脉或血管手术或肠切除术的 RA 患者，并在手术前 90 天内使用英夫利昔单抗治疗。我们研究了输注时间与术后 30 天内感染和死亡之间的关系。我们调整了术后感染或死亡的预测概率、人口统计学特征、使用 MTX、术后输血和医院容量。
我们研究了 712 例 CABG 患者、244 例血管手术患者和 862 例肠切除术患者。术后肺炎发生率为 7.4%-11.9%，尿路感染发生率为 9.0%-15.2%，手术部位感染发生率为 3.2%-18.9%，脓毒症发生率为 4.2%-9.6%，死亡率为 3.5%-7.0%。在任何手术队列中，从最后一次英夫利昔单抗剂量到手术的时间与术后感染或死亡率的风险之间均无关联。没有发现使用英夫利昔单抗的时间越接近，感染风险就越高的亚组。
在老年 RA 患者中，重大手术后感染和死亡的风险与英夫利昔单抗输注的术前时间无关。
