Background A perioperative management of antirheumatic drug therapy guidelines was published by the American College of Rheumatology in 2017. The optimal perioperative management of inmunosuppressant therapy may present an opportunity to mitigate post-surgery infection risk versus disease flare risk if the medication is withheld.
Purpose To evaluate the accuracy between the real practice in perioperative management of patients with rheumatic diseases and the guideline recommendations, and to assess post-surgery complications and identify associated risk factors.
Material and methods Retrospective, observational study. Adult patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) in treatment with biologic agents while undergoing surgery between January 2017 and August 2018 were included.
Diagnosis, anthirreumatic treatment (biologic agent, disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids) and doses.
Continuation/interruption of DMARDs and biologic agent, time of reintroducing them and glucocorticoid adjustment dose during surgery.
Post-surgery complications: infections and disease flares.
Data collected:Descriptive statistics and binary logistic regression were performed with SPSS 20.0.
Results Forty-seven patients were included: 63.,8% RA, 19.1% SpA and 17.1% PsA. Anti-TNFα agents were used in 76.5% patients, from which 14% of patients required an intensified dose. DMARDs were combined with biologic therapy in 63.8%, while glucocorticoids were used in 44.7%.
During perioperatory time and according to guidelines, a total of 93.3% continued with DMARDs and 95.2% with glucocorticoids when the daily dose of prednisone or equivalent was <20 mg. Nevertheless, 14.8% interrupted the biologic agent, from which 42.8% of the surgeries were scheduled at the end of the biological therapy cycle and no patient was properly reintroduced to a biologic agent after 14 days from surgery.
Post-surgery infection complications appeared in 8.5% and no patient had disease flare during the post-operative stage.
No association between infection complications and perioperative mismanagement of biologic agents (P: 0.359), nor with the biologic therapy-intensified dose (P: 0.379).
Perioperative management of biologic therapy in real practice was not according to guidelines, while with DMARDS and glucocorticoids it was appropiate.
We have not found risk factors associated with post-surgical complications in rheumatic diseases.
Perioperative management could be a new challenge in the pharmaceutical care of biologic therapies.
References and/or acknowledgements No conflict of interest.
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