Objectives The impact of immunosuppression on postoperative outcomes has primarily been studied in patients undergoing joint replacement surgery. We aimed to evaluate the impact of biologics and glucocorticoids on outcomes after other major surgeries. Methods This retrospective cohort study used Medicare data 2006–2015 to identified 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). Logistic regression with propensity-score-based inverse probability weighting compared 90-day mortality and 30-day readmission in patients 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. Similar analyses evaluated associations between glucocorticoids and outcomes. Results We identified 10 777 eligible surgeries: 3585 hip fracture, 5025 abdominopelvic and 2167 cardiac surgeries. Compared with patients receiving methotrexate, there was no increase in the risk of 90-day mortality or 30-day readmission among patients receiving a TNFi (mortality adjusted OR (aOR) 0.83 (0.67 to 1.02), readmission aOR 0.86 (0.75 to 0.993)) or non-TNFi biologic/tsDMARD (mortality aOR 0.78 (0.49 to 1.22), readmission aOR 1.02 (0.78 to 1.33)). Analyses stratified by surgery category were similar. Risk of mortality and readmission was higher with 5–10 mg/day of glucocorticoids (mortality aOR 1.41 (1.08 to 1.82), readmission aOR 1.26 (1.05 to 1.52)) or >10 mg/day (mortality aOR 1.64 (1.02 to 2.64), readmission aOR 1.60 (1.15 to 2.24)) versus no glucocorticoids, although results varied when stratifying by surgery category. Conclusions Recent biologic or tsDMARD use was not associated with a greater risk of mortality or readmission after hip fracture, abdominopelvic or cardiac surgery compared with methotrexate. Higher dose glucocorticoids were associated with greater risk.

中文翻译：

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接受髋部骨折、腹盆腔和心脏手术的类风湿关节炎患者的免疫抑制以及再入院和死亡的风险


目的 主要在接受关节置换手术的患者中研究免疫抑制对术后结果的影响。我们的目的是评估生物制剂和糖皮质激素对其他重大手术后结果的影响。方法 这项回顾性队列研究使用 2006-2015 年医疗保险数据来确定接受髋部骨折修复、腹盆腔手术（胆囊切除术、子宫切除术、疝气、阑尾切除术、结肠切除术）或心脏手术（冠状动脉旁路移植术、二尖瓣/主动脉瓣）的成人类风湿关节炎患者。采用基于倾向评分的逆概率加权的逻辑回归比较了接受甲氨蝶呤（未使用生物制剂或靶向合成缓解病情抗风湿药 (tsDMARD)）、肿瘤坏死因子抑制剂 (TNFi) 的患者的 90 天死亡率和 30 天再入院率或手术前 8 周服用非 TNFi 生物制剂/tsDMARD <。类似的分析评估了糖皮质激素与结果之间的关联。结果 我们确定了 10 777 例符合条件的手术：3585 例髋部骨折手术、5025 例腹盆腔手术和 2167 例心脏手术。与接受甲氨蝶呤的患者相比，接受 TNFi 治疗的患者 90 天死亡率或 30 天再入院风险没有增加（死亡率调整 OR (aOR) 0.83（0.67 至 1.02），再入院 aOR 0.86（0.75 至 0.993）） ）或非 TNFi 生物制剂/tsDMARD（死亡率 aOR 0.78（0.49 至 1.22），再入院 aOR 1.02（0.78 至 1.33））。按手术类别分层的分析相似。 5–10 mg/天糖皮质激素的死亡率和再入院风险较高（死亡率 aOR 1.41（1.08 至 1.82），再入院 aOR 1.26（1.05 至 1.52））或 >10 mg/天（死亡率 aOR 1.64（1.02 至 2.64）） ，再入院 aOR 1.60（1.15 至 2.24)) 与不使用糖皮质激素相比，尽管按手术类别分层时结果有所不同。结论 与甲氨蝶呤相比，近期使用生物制剂或 tsDMARD 与髋部骨折、腹盆腔或心脏手术后死亡或再入院风险较高无关。较高剂量的糖皮质激素与较高的风险相关。