Abstract
Introduction. International guidelines recommend interruption of anti-TNF medications in the perioperative period, but there are no randomized trials to support such recommendation. Objectives. To study literature evidence assessing the risk of surgical site infections in orthopedic surgery patients with RA using anti-TNF drugs, compared to untreated patients or those using conventional DMARD. Methods. Systematic review of cohort studies is concerning surgical site infections in orthopedic procedures in patients with RA. Results. Three studies were selected. Only one was considered of high-quality, albeit with low statistical power. The review resulted in inconclusive data, since the best quality study showed no significant differences between groups, while others showed increased risk of infections in patients using anti-TNF medications. Conclusion. It is unclear whether patients with RA using anti-TNF medications are at increased risk of surgical site infections. Randomized controlled trials or new high quality observational studies are needed to clarify the issue.
Highlights
International guidelines recommend interruption of anti-TNF medications in the perioperative period, but there are no randomized trials to support such recommendation
Six abstracts were selected according to inclusion criteria and, after general manuscript reading, three studies [19,20,21] were included in the review
In addition to the primary outcome, this study evaluated the incidence of wound dehiscence, bleeding or hematoma, subluxation, reoperation, and death
Summary
International guidelines recommend interruption of anti-TNF medications in the perioperative period, but there are no randomized trials to support such recommendation. To study literature evidence assessing the risk of surgical site infections in orthopedic surgery patients with RA using anti-TNF drugs, compared to untreated patients or those using conventional DMARD. Systematic review of cohort studies is concerning surgical site infections in orthopedic procedures in patients with RA. The review resulted in inconclusive data, since the best quality study showed no significant differences between groups, while others showed increased risk of infections in patients using anti-TNF medications. It is unclear whether patients with RA using anti-TNF medications are at increased risk of surgical site infections. Most patients with RA are in use of conventional modifying disease activity drugs (DMARD), and some of them are on antagonists of tumor necrosis factor (anti-TNF) medications [3, 4]. Systematic reviews have shown no increased risk of bacterial infections after treatment with such drugs [5, 6].
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