Abstract
BACKGROUND CONTEXT
Lumbar discectomy is a common procedure for which patients with rheumatoid arthritis
(RA) may be considered. RA is an autoinflammatory disease that may predispose patients
to postoperative adverse outcomes.
PURPOSE
To assess the relative odds of adverse events after lumbar discectomy for those with
versus without RA in a large, national, administrative dataset.
STUDY DESIGN/SETTING
Retrospective cohort study using the 2010 to 2020 MSpine PearlDiver dataset.
PATIENT SAMPLE
After exclusion of patients under 18 years old, those with any trauma, neoplasm, or
infection diagnosis within the month before lumbar discectomy, and any patients who
had any alternative lumbar spinal surgery performed on the same day as lumbar discectomy,
we identified 36,479 lumbar discectomy patients. 2,937 (8.1%) of these patients had
a prior diagnosis of RA. After matching 4:1 by patient age, sex, and Elixhauser Comorbidity
Index (ECI, a longitudinal measure of patient comorbidity burden generated via ICD-9
and 10 diagnosis codes), 8,485 lumbar discectomy patients without RA and 2,149 with
RA were included.
OUTCOME MEASURES
Incidence of severe and minor adverse events in the 90-days following lumbar discectomy,
predictive factors for adverse events within 90-days of lumbar discectomy, risk of
adverse events within 90-days of lumbar discectomy stratified by patient medication
regimen, 5-year survival to reoperation following lumbar discectomy.
METHODS
Patients undergoing lumbar discectomy were identified from the PearlDiver MSpine dataset.
The subset of those with versus without RA were identified and matched 1:4 based on
patient age, sex, and ECI scores. The incidence of 90-day adverse events in the two
groups was determined and compared by univariate and multivariate analyses. Subgroup
analysis was performed based on RA medications being taken.
RESULTS
Matched lumbar discectomy patients with RA (n=2,149) and without RA (n=8,485) were
identified. Controlling for patient age, sex, and ECI, those with RA were at significantly
higher odds of any (odds ratio [OR] 3.30), severe (OR 2.78), and minor (OR 3.30) adverse
events (p<.0001 for all).
Stratifying by medications being taken (and relative to those without RA), there was
increasing odds of all adverse events (AAE) based on potency of medications (no biologic
or disease modifying antirheumatic drugs [DMARDs] OR 2.33, DMARDs only OR 3.86, biologic±DMARDs
OR 5.69 (p<.0001 for all). Despite this, no statistically significant difference in
5-year survival from subsequent lumbar surgery was found between those with versus
without RA (p=.1000).
CONCLUSIONS
Lumbar discectomy patients with RA were found to be at significantly higher risk for
90-day adverse events following lumbar discectomy, and this was incrementally greater
for those on increasingly suppressive medications. Lumbar discectomy patients with
RA bear specific consideration and perioperative monitoring when considered for lumbar
discectomy.
Keywords
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References
Butler AJ DIC. Discectomy. StatPearls [serial on the Internet]. 2022.
- A 2-Year outcomes and complications of various techniques of lumbar discectomy: a multicentric retrospective study.World Neurosurg. 2021; 156: e319-ee28
- Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial.JAMA. 2006; 296: 2441-2450
- Risk factors for and timing of adverse events after total shoulder arthroplasty.J Shoulder Elbow Surg. 2017; 26: 1003-1010
- Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation.Bone Joint J. 2019; 101-b: 470-477
- Cost and complications of single-level lumbar decompression in those over and under 75: a matched comparison.Spine. 2021; 46: 29-34
- Of 20,376 lumbar discectomies, 2.6% of patients readmitted within 30 days: surgical site infection, pain, and thromboembolic events are the most common reasons for readmission.Spine (Phila Pa 1976). 2017; 42: 1267-1273
- Diabetes and early postoperative outcomes following lumbar fusion.Spine (Phila Pa 1976). 2007; 32: 2214-2219
- Diabetes associated with increased surgical site infections in spinal arthrodesis.Clin Orthop Relat Res. 2009; 467: 1670-1673
- Risk factors for adverse cardiac events after lumbar spine fusion.Int J Spine Surg. 2018; 12: 638-643
- Incidence and risk factors for 30-day unplanned readmissions after elective posterior lumbar fusion.Spine (Phila Pa 1976). 2018; 43: 41-48
- The impact of rheumatoid arthritis on the risk of adverse events following joint replacement: a real-world cohort study.Clin Epidemiol. 2018; 10: 697-704
- Rheumatoid arthritis: preoperative evaluation for total hip and total knee replacement surgery.J Clin Rheumatol. 2013; 19: 187-192
- Rheumatoid arthritis: common questions about diagnosis and management.Am Fam Physician. 2018; 97: 455-462
- Rheumatoid arthritis and the cervical spine: a review on the role of surgery.Int J Rheumatol. 2015; 2015252456
- Management of rheumatoid arthritis: an overview.Cells. 2021; 10: 2857
- Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies.Bone Res. 2018; 6: 15
- Postoperative outcomes after degenerative lumbar spine surgery in rheumatoid arthritis patients -a propensity score-matched analysis.BMC Musculoskelet Disord. 2022; 23: 380
- Lumbar spine surgery in patients with rheumatoid arthritis (RA): what affects the outcomes?.Spine J. 2018; 18: 99-106
- Emergency department visits within 90 days of anterior cruciate ligament reconstruction.Orthop J Sports Med. 2022; 10 (23259671221083586)
- Emergency department visits within 90 days of single-level anterior cervical discectomy and fusion.N Am Spine Soc J. 2022; 10100122
- Four-level anterior versus posterior cervical fusions: Perioperative outcomes and five-year reoperation rates: Outcomes after four-level anterior versus posterior cervical procedures.N Am Spine Soc J. 2022; 10: 100115
- Single-level posterior lumbar fusions in patients with Ehlers Danlos Syndrome not found to be associated with increased postoperative adverse events or five-year reoperations.N Am Spine Soc J. 2022; 11100136
- Buch MH,et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA).Ann Rheum Dis. 2014; 73: 62-68
- Rheumatoid arthritis increases risk of medical complications following posterior lumbar fusion.World Neurosurg. 2021; 149: e729-ee36
- Myocardial infarction and mortality following joint surgery in patients with rheumatoid arthritis: a retrospective cohort study.Arthritis Res Ther. 2016; 18: 69
- Rheumatoid arthritis and thrombosis.Clin Exp Rheumatol. 2009; 27: 846-855
- Comparative risk of cardiovascular events with biologic and synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a systematic review and meta-analysis.Arthritis Care Res (Hoboken). 2020; 72: 561-576
- Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis.Int Wound J. 2017; 14: 529-536
- Early morbidity after total hip replacement: rheumatoid arthritis versus osteoarthritis.J Gen Intern Med. 1990; 5: 304-309
- Tumor necrosis factor inhibitor therapy and risk of serious postoperative orthopedic infection in rheumatoid arthritis.Arthritis Rheum. 2006; 55: 333-337
- Beyond the joints, the extra-articular manifestations in rheumatoid arthritis.Autoimmun Rev. 2021; 20: 102735
- Rheumatoid arthritis: extra-articular manifestations and comorbidities.Autoimmun Rev. 2021; 20102776
- Increased risk of acute pancreatitis in patients with rheumatoid arthritis: a population-based cohort study.PLoS One. 2015; 10e0135187
- [Pulmonary cytotoxicity induced by bleomycin and methotrexate].Vestn Rentgenol Radiol. 2015; : 46-51
- Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: a current perspective.Biochem Pharmacol. 2020; 180114147
- Rheumatoid anemia.Joint Bone Spine. 2011; 78: 131-137
- Long-term results of shoulder hemiarthroplasty in patients with rheumatoid arthritis.Orthopedics. 2015; 38: e38-e42
Article info
Publication history
Published online: March 26, 2023
Accepted:
March 20,
2023
Received in revised form:
February 26,
2023
Received:
October 30,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
Author disclosures: PPR: Grant: National Heart, Lung, and Blood Institute of the NIH (B). KER: Nothing to disclose. MJG: Nothing to disclose. AJK: Nothing to disclose. JNG: Board of Directors: North American Spine Society (nonfinancial).
Identification
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