The study also finds no evidence that RA is associated with an increased risk of other types of complications related to inflammation. Dr. Alparslan Turan and colleagues of the Cleveland Clinic write, "We expected to find an increased risk of cardiovascular, thromboembolic, and microcirculatory complications in RA patients; our results did not support this association."
Surprisingly, No Increase in Postoperative Complications in RA PatientsUsing a large hospital database, the researchers identified two matched groups of patients who underwent surgery at hospitals in seven states in 2009-10. Each group consisted of about 67,000 patients: one group with RA and one group without RA. The two groups were otherwise similar in terms of sex, age, and type of surgery, as well as for characteristics associated with propensity to develop RA.
Dr. Turan and colleagues compared rates of cardiovascular complications, such as cardiac arrest and heart attack, for patients with and without RA. They also compared the risk of thromboembolic, or blood clot-related, complications; microcirculatory complications, such as kidney failure or wound-healing problems; and death in the hospital. The researchers hypothesized that some or all of these surgical risks would be higher in the RA group.
But the results showed no significant difference between groups in any of these adverse outcomes. Cardiovascular complications occurred in 1.64 percent of RA patients compared to 1.50 percent of controls without RA. Rates of in-hospital death were 1.44 and 1.28 percent, respectively.
Rates of thromboembolic and microcirculatory complications were also similar for matched patients with versus without RA. Further analysis suggested that any small differences in the risk of adverse outcomes might be related to the presence of chronic heart disease in patients with RA. However, the differences were still not statistically significant.
Rheumatoid arthritis, the most common cause of inflammatory arthritis, is associated with progressive, chronic inflammation resulting in the destruction of the joints. In the surgical database used, RA was present in 1.27 percent of patients. That was within the one to five percent prevalence range reported in previous studies
Patients with RA have a higher overall mortality rate, mainly reflecting an increased risk of cardiovascular events. Those associations raise concerns that RA patients may have higher rates of postoperative complications.
Surgery provokes the release of inflammatory mediators, which—added to the patient's chronic RA-related inflammation—might lead to increased rates of postoperative cardiovascular events and death. Many RA patients also have disabilities and functional limitations that may affect decisions about their fitness to undergo surgery.
However, the new study finds no little or no difference in postoperative complications or mortality in matched groups of patients with and without RA. Dr. Turan and coauthors write, "This result is surprising since RA provokes substantial persistent inflammation, which is believed to cause premature development of atherosclerosis, along with venous and arterial thromboembolism."
While acknowledging some key limitations of their data, the researchers note, "By far this is the largest study of RA and perioperative cardiovascular events." The results may have important implications for understanding the risks of surgery for patients with RA, including judgments as to whether patients are healthy enough to undergo surgery. Dr. Turan and colleagues add that the lack of difference in mortality may be because this risk is "overwhelmingly determined" by other patient and surgical characteristics, rather than by RA itself.
Anesthesia & Analgesia is published by Wolters Kluwer.
Read the article in Anesthesia & Analgesia.
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