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Continuation of TNF blockade in patients with inflammatory rheumatic disease. An observational study on surgical site infections in 1,596 elective orthopedic and hand surgery procedures

Berthold, Elisabet LU ; Geborek, Pierre LU and Gülfe, Anders LU (2013) In Acta Orthopaedica 84(5). p.495-501
Abstract

BACKGROUND: Increased infection risk in inflammatory rheumatic diseases may be due to inflammation or immunosuppressive treatment. The influence of tumor necrosis factor (TNF) inhibitors on the risk of developing surgical site infections (SSIs) is not fully known. We compared the incidence of SSI after elective orthopedic surgery or hand surgery in patients with a rheumatic disease when TNF inhibitors were continued or discontinued perioperatively.

PATIENTS AND METHODS: We included 1,551 patients admitted for elective orthopedic surgery or hand surgery between January 1, 2003 and September 30, 2009. Patient demographic data, previous and current treatment, and factors related to disease severity were collected. Surgical procedures... (More)

BACKGROUND: Increased infection risk in inflammatory rheumatic diseases may be due to inflammation or immunosuppressive treatment. The influence of tumor necrosis factor (TNF) inhibitors on the risk of developing surgical site infections (SSIs) is not fully known. We compared the incidence of SSI after elective orthopedic surgery or hand surgery in patients with a rheumatic disease when TNF inhibitors were continued or discontinued perioperatively.

PATIENTS AND METHODS: We included 1,551 patients admitted for elective orthopedic surgery or hand surgery between January 1, 2003 and September 30, 2009. Patient demographic data, previous and current treatment, and factors related to disease severity were collected. Surgical procedures were grouped as hand surgery, foot surgery, implant-related surgery, and other surgery. Infections were recorded and defined according to the 1992 Centers for Disease Control definitions for SSI. In 2003-2005, TNF inhibitors were discontinued perioperatively (group A) but not during 2006-2009 (group B).

RESULTS: In group A, there were 28 cases of infection in 870 procedures (3.2%) and in group B, there were 35 infections in 681 procedures (5.1%) (p = < 0.05). Only foot surgery had significantly more SSIs in group B, with very low rates in group A. In multivariable analysis with groups A and B merged, only age was predictive of SSI in a statistically significant manner.

INTERPRETATION: Overall, the SSI rates were higher after abolishing the discontinuation of anti-TNF perioperatively, possibly due to unusually low rates in the comparator group. None of the medical treatments analyzed, e.g. methotrexate or TNF inhibitors, were significant risk factors for SSI. Continuation of TNF blockade perioperatively remains a routine at our center.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Antirheumatic Agents, Arthritis, Rheumatoid, Elective Surgical Procedures, Female, Hand, Humans, Incidence, Male, Methotrexate, Middle Aged, Surgical Wound Infection, Tumor Necrosis Factor-alpha, Observational Study
in
Acta Orthopaedica
volume
84
issue
5
pages
7 pages
publisher
Taylor & Francis
external identifiers
  • wos:000326679000011
  • pmid:24032521
  • scopus:84887471472
  • pmid:24032521
ISSN
1745-3682
DOI
10.3109/17453674.2013.842431
language
English
LU publication?
yes
id
49edcb4f-f177-4cd4-b5e3-007cf0be0772 (old id 4065907)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24032521?dopt=Abstract
date added to LUP
2016-04-01 10:24:53
date last changed
2020-07-29 01:33:14
@article{49edcb4f-f177-4cd4-b5e3-007cf0be0772,
  abstract     = {<p>BACKGROUND: Increased infection risk in inflammatory rheumatic diseases may be due to inflammation or immunosuppressive treatment. The influence of tumor necrosis factor (TNF) inhibitors on the risk of developing surgical site infections (SSIs) is not fully known. We compared the incidence of SSI after elective orthopedic surgery or hand surgery in patients with a rheumatic disease when TNF inhibitors were continued or discontinued perioperatively.</p><p>PATIENTS AND METHODS: We included 1,551 patients admitted for elective orthopedic surgery or hand surgery between January 1, 2003 and September 30, 2009. Patient demographic data, previous and current treatment, and factors related to disease severity were collected. Surgical procedures were grouped as hand surgery, foot surgery, implant-related surgery, and other surgery. Infections were recorded and defined according to the 1992 Centers for Disease Control definitions for SSI. In 2003-2005, TNF inhibitors were discontinued perioperatively (group A) but not during 2006-2009 (group B).</p><p>RESULTS: In group A, there were 28 cases of infection in 870 procedures (3.2%) and in group B, there were 35 infections in 681 procedures (5.1%) (p = &lt; 0.05). Only foot surgery had significantly more SSIs in group B, with very low rates in group A. In multivariable analysis with groups A and B merged, only age was predictive of SSI in a statistically significant manner.</p><p>INTERPRETATION: Overall, the SSI rates were higher after abolishing the discontinuation of anti-TNF perioperatively, possibly due to unusually low rates in the comparator group. None of the medical treatments analyzed, e.g. methotrexate or TNF inhibitors, were significant risk factors for SSI. Continuation of TNF blockade perioperatively remains a routine at our center.</p>},
  author       = {Berthold, Elisabet and Geborek, Pierre and Gülfe, Anders},
  issn         = {1745-3682},
  language     = {eng},
  number       = {5},
  pages        = {495--501},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Continuation of TNF blockade in patients with inflammatory rheumatic disease. An observational study on surgical site infections in 1,596 elective orthopedic and hand surgery procedures},
  url          = {https://lup.lub.lu.se/search/ws/files/1825885/4281055.pdf},
  doi          = {10.3109/17453674.2013.842431},
  volume       = {84},
  year         = {2013},
}