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• W4386041777 abstract "BACKGROUND CONTEXT Lumbar discectomy is commonly performed in rheumatoid arthritis (RA) patients. Knowing that those with RA are at increased risk of adverse events after other procedures, their relative risk after lumbar discectomy was assessed. STUDY DESIGN/SETTING Retrospective cohort study. METHODS Lumbar discectomy patients were identified from the PearlDiver MSpine dataset. Those with RA were identified and matched 1:4 to those without RA based on patient age, sex, and Elixhauser Comorbidity Index (ECI) scores. The incidence of 90-day adverse events in the two groups was determined and compared by univariate and multivariate analyses. Lumbar discectomy patients with RA were then categorized based on prescribed medications: no biologics or disease-modifying antirheumatic drugs (DMARDs), DMARDs only, or biologics ± DMARDs. Multivariate logistic regression was performed to determine the odds of experiencing any adverse events (AAE) for those in the medication subgroups (relative to those without RA) in the 90 days postoperatively. RESULTS After matching, 2,149 lumbar discectomy patients with RA and 8,485 without RA were identified. RA patients had a greater incidence of AAE (32.0% versus 12.8%, p<0.0001). Controlling for patient age, sex, and ECI, those with RA were at significantly higher risk for any (odds ratio [OR] 3.30), severe (OR 2.78), and minor (OR 3.30) adverse events compared to those without (p<0.0001 for all). Stratifying by medication and relative to those without RA, RA patients on biologic ± DMARD therapy were at the highest risk for any adverse event following surgery (OR 5.69), followed by those on DMARDs alone (OR 3.87), and those not on biologic or DMARD therapy (OR 2.33) (p<0.0001 for all). No statistically significant difference in 5-year survival to subsequent lumbar surgery was found between patients with and without RA (p=0.1000). CONCLUSIONS Lumbar discectomy patients with RA were at significantly higher risk for 90-day adverse events following lumbar discectomy, with incrementally greater risk for those on increasingly immunosuppressive medications. There was no difference in 5-year survival to reoperation between patients with and without RA. RA patients should be counseled about the greater risk of postoperative adverse events when undergoing lumbar discectomy. The greater risks associated with increasingly immunosuppressive medications raise the question of holding such drugs perioperatively. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Lumbar discectomy is commonly performed in rheumatoid arthritis (RA) patients. Knowing that those with RA are at increased risk of adverse events after other procedures, their relative risk after lumbar discectomy was assessed. Retrospective cohort study. Lumbar discectomy patients were identified from the PearlDiver MSpine dataset. Those with RA were identified and matched 1:4 to those without RA based on patient age, sex, and Elixhauser Comorbidity Index (ECI) scores. The incidence of 90-day adverse events in the two groups was determined and compared by univariate and multivariate analyses. Lumbar discectomy patients with RA were then categorized based on prescribed medications: no biologics or disease-modifying antirheumatic drugs (DMARDs), DMARDs only, or biologics ± DMARDs. Multivariate logistic regression was performed to determine the odds of experiencing any adverse events (AAE) for those in the medication subgroups (relative to those without RA) in the 90 days postoperatively. After matching, 2,149 lumbar discectomy patients with RA and 8,485 without RA were identified. RA patients had a greater incidence of AAE (32.0% versus 12.8%, p<0.0001). Controlling for patient age, sex, and ECI, those with RA were at significantly higher risk for any (odds ratio [OR] 3.30), severe (OR 2.78), and minor (OR 3.30) adverse events compared to those without (p<0.0001 for all). Stratifying by medication and relative to those without RA, RA patients on biologic ± DMARD therapy were at the highest risk for any adverse event following surgery (OR 5.69), followed by those on DMARDs alone (OR 3.87), and those not on biologic or DMARD therapy (OR 2.33) (p<0.0001 for all). No statistically significant difference in 5-year survival to subsequent lumbar surgery was found between patients with and without RA (p=0.1000). Lumbar discectomy patients with RA were at significantly higher risk for 90-day adverse events following lumbar discectomy, with incrementally greater risk for those on increasingly immunosuppressive medications. There was no difference in 5-year survival to reoperation between patients with and without RA. RA patients should be counseled about the greater risk of postoperative adverse events when undergoing lumbar discectomy. The greater risks associated with increasingly immunosuppressive medications raise the question of holding such drugs perioperatively." @default.
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• W4386041777 date "2023-09-01" @default.
• W4386041777 modified "2023-10-09" @default.
• W4386041777 title "P33. Rheumatoid arthritis patients are at increased risk for adverse events following lumbar discectomy" @default.
• W4386041777 doi "https://doi.org/10.1016/j.spinee.2023.06.258" @default.
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