Postoperative complications in rheumatic disease patients undergoing arthroscopy on immunosuppression

ABSTRACT

Background

There are currently no guidelines on peri-arthroscopic management of immunosuppressive (IS) treatment in rheumatic disease patients.

Purpose

The purpose of this study is to characterize the rheumatic disease patient population undergoing arthroscopy, compare the incidence of postoperative complications among patients who either remained on IS perioperatively, held IS perioperatively or were not on IS at baseline, and compare the incidence of postoperative complications by rheumatic disease type, medication type, and procedure.

Methods

We conducted a retrospective review of all arthroscopic sports medicine surgeries in patients with a rheumatic disease diagnosis at our institution over an 11-year period. Patients on IS at baseline were grouped into those who remained on IS perioperatively or held all IS before the date of their surgery. These two groups were compared to patients who were not on IS at baseline. Incidence of postoperative complications was calculated for the three cohorts and by medication class, rheumatic disease type, and procedure risk. Analysis of variance (ANOVA), chi-squared, and Fisher’s exact tests were used to determine the statistical significance of between-group differences in postoperative complication incidence.

Results

We identified 1,316 rheumatic disease patients undergoing arthroscopy, with 214 of them taking IS medications at baseline. In total, 8.4% (n = 110) remained on IS perioperatively, 7.9% (n = 104) held IS perioperatively, and 83.7% (n = 1102) were not on IS at baseline. In all cohorts, seven patients experienced postoperative complications; six of whom experienced infections. Two (1.82%) occurred in patients remaining on IS perioperatively, zero infections occured in patients who held all IS, and four (0.36%) occured in patients who were not on any IS at baseline. There was no statistically significant difference in postoperative infections or complication rates among the three cohorts or further subgroups.

Conclusion

The risk of postoperative complications including infectious, major, and minor complications in patients on IS at the time of arthroscopy is low and acceptable.

KEYWORDS:

• Perioperative
• csDMARD
• biologics
• glucocorticoids
• postoperative infection
• rheumatic

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00913847.2024.2324363

Ethics approval and consent

Institutional Review Board was obtained at NYU Langone Health, study number s21–00920. All study activities were conducted after IRB approval was obtained, and were done in concordance with institutional ethics and consent policies.

Competing interests

LMJ receives fellowship support from Arthrex, Smith & Nephew, and AANA. JS, CCL, and KV have no conflicts of interest to report.

Author contributions

All authors contributed to the study conception and design. All authors read and approved the final manuscript.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.