Poster 103: Incidence of postoperative infections in rheumatic disease patients undergoing arthroscopy was not affected by use of immunosuppressive medications

Abstract

Objectives:Although guidelines exist for perioperative management of immunosuppressive (IS) treatment in rheumatic disease patients around the time of total joint arthroplasty, there are no such guidelines or reports in the literature for arthroscopy. The purpose of this study is to compare the incidence of infectious complications in patients with rheumatic diseases undergoing arthroscopic surgery who either 1) remained on IS perioperatively, 2) held IS perioperatively or 3) were not on IS at baseline.Methods:We conducted a retrospective review of all arthroscopic surgeries in patients with a rheumatic disease diagnosis at our institution over a 10-year period. Inclusion criteria included an underlying diagnosis of one of the following: spondyloarthritis (reactive arthritis, psoriatic arthritis, ankylosing spondylitis, enteropathic arthritis), rheumatoid arthritis, systemic lupus erythematosus, juvenile idiopathic arthritis, polymyalgia rheumatica, dermatomyositis, polymyositis, and sarcoidosis. Patients on IS at baseline (medication classes including conventional synthetic disease-modifying drugs (csDMARDs), biologics, janus kinase (JAK) inhibitors, glucocorticoids, or a combination of two or three of medications) were grouped into those who remained on IS perioperatively versus those who had IS held before the date of their surgery. These two groups were compared to patients who were not on IS at baseline. Demographic data and 90-day postoperative infections (superficial surgical site infections (SSI), deep SSI, septic arthritis, and prosthetic joint infection) were analyzed. Incidence of postoperative complications was calculated for the three cohorts and by medication class. Analysis of variance (ANOVA) was used to determine the statistical significance of between-group differences in postoperative infection incidence.Results:We identified 1,316 rheumatic disease patients undergoing arthroscopy, with 214 of them taking IS medications at baseline. Among patients on IS, patients were most frequently on glucocorticoids (5.2%, n= 69), followed by a combination of 2 or more immunosuppressive medications (3.8%, n=50), csDMARDS (3.6%, n=48), biologics (3.4%, n=45), and JAK inhibitors (0.2%, n=2). Overall, 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. There were two cases (1.82%) of infections among patients remaining on IS perioperatively (one on glucocorticoids and the other taking multiple medications), zero cases (0%) of infection in patients who held IS, and four cases (0.36%) of post-operative infection in patients who were not on IS at baseline. There was no statistically significant difference in infection rates among the three cohorts – nor any stratified risk between the various medication classes.Conclusions:This study is the first to suggest that patients with rheumatic diseases undergoing arthroscopy may remain on immunosuppression perioperatively without significant risk for infection.