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Immunosuppression and the risk of readmission and mortality in patients with rheumatoid arthritis undergoing hip fracture, abdominopelvic and cardiac surgery

Annals of Rheumatic Diseases Mar 27, 2020

George MD, Baker JF, Winthrop KL, et al. - This study was sought to assess the effect of biologics and glucocorticoids on outcomes after other major surgeries. Researchers conducted a retrospective cohort study to apply Medicare data 2006–2015 to distinguish adults with rheumatoid arthritis undergoing hip fracture repair, abdominopelvic surgery (cholecystectomy, hysterectomy, hernia, appendectomy, colectomy) or cardiac surgery (coronary artery bypass graft, mitral/aortic valve). They performed logistic regression with propensity-score-based inverse probability weighting to compare 90-day mortality and 30-day readmission in individuals receiving methotrexate (without a biologic or targeted synthetic disease-modifying antirheumatic drug (tsDMARD)), a tumour necrosis factor inhibitor (TNFi) or a non-TNFi biologic/tsDMARD < 8 weeks before surgery.  Relationships between glucocorticoids and outcomes were analyzed by similar analyses. Compared with methotrexate, recent biologic or tsDMARD use was not correlated with a greater risk of mortality or readmission after hip fracture, abdominopelvic or cardiac surgery. The evidence showed that higher dose glucocorticoids were correlated with greater risk.

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