Post-Operative Complications of Immunosuppressive Medications for Patients undergoing Hand and Wrist Surgery
Ellis Berns, MD1, Katherine Grunzweig, MD2, Thompson Zhuang, MD MBA1 and Andrew D Sobel, MD1, (1)University of Pennsylvania, Philadelphia, PA, (2)Univeristy of Pennsylvannia, Philadelphia, PA
Title: Post-operative Complications after the use of Immunosuppressive Medications for Patients undergoing Hand and Wrist Surgery
Introduction: Despite the frequent co-incidence of rheumatologic disease and hand and wrist surgery, guidance regarding the peri-operative use of immunosuppressive medications is limited. Recommendations are often deferred to literature regarding total hip and knee arthroplasty. Research regarding outcomes of patients who take immunosuppressive medications allows for hand and wrist surgeons to adequately guide their patients on use or disuse of immunosuppressives peri-operatively.
Methods: 47,871 CPT codes relating to bony and soft tissue procedures distal to the forearm were analyzed for selected for analysis. We compared the rate of complications post operatively including antibiotic prescription, hospital re-admission, wound healing complications, tendon rupture, and return to the operating room using multivariate logistic regression. Medications were grouped into disease modifying anti-rheumotologic drugs (DMARD), Biologics, or specific systemic lupus erythematosus medications (SLE) and recorded if the patient took their medication within 90 days before their procedure.
Results: Odds Ratios were calculated and adjusted for race, sex, rheumatologic disease (SLE, RA with and without rheumatoid factor, UC, Crohnâ€™s, Sjogren, Psoriasis, tobacco use, alcohol use, diabetes, hypertension, peripheral vascular disease. The following odds ratio for tendon rupture were when taking a DMARD (1.69, p<.05), Biologic (3.42, p.002), SLE specific medication (1.62, p=.15) The odds ratio for return to the operating room were when taking a DMARD (1.69, p<.05), Biologic (3.42, p.002), SLE specific medication (1.62, p=.15). The odds ratio for antibiotic prescribed were when taking a DMARD (1.65, p<.05), Biologic (2.3, p=.07), SLE specific medication (.94, p=.91). The odds ratio for readmission within 90 days werwe when taking a DMARD (1.35, p=.09), Biologic (2.73, p=.18), SLE specific medication (3.98, p=.006). The following odds ratio for wound healing complications were when taking a DMARD (1.36, p<.001), Biologic (2.85, p.01), SLE specific medication (1.31, p=.51).
Conclusion: Peri-operative use of immunosuppressive medications such as DMARDS and biologics increases the risk of tendon rupture, return to the operating room, antibiotic prescription, wound healing. Counseling patients on holding their DMARD or biologic prior to their procedure may be indicated with discussion with their rheumatologist and the risk of disease flare. Given the frequent co-incidence of rheumatologic disease and hand and wrist surgery, hand surgeons should be able to recommend to patients to hold anti-rheumatologic medication prior to their procedure.
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