Risk factors for early wound complications after orthopedic surgery for rheumatoid arthritis

Agustin Escalante, T. D. Beardmore

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Objective. To identify risk factors for the occurrence of early wound complications following orthopedic surgery in patients with rheumatoid arthritis (RA). Methods, We reviewed records of patients with RA undergoing joint surgery to identify predictors of the following early postoperative surgical outcomes: (1) prolonged drainage; (2) wound cellulitis; (3) wound dehiscence; (4) suture abscess; and (5) superficial or deep wound infection. Results. During the study, 204 patients with RA underwent 119 total knee replacements, 105 to,tal hip replacements and 143 procedures of other joints, for a total of 367 orthopedic surgeries. A total of 57 complications were observed (15.9%) of which 26 were considered major (7%). Of the 230 total arthroplasties of the hip, knee, shoulder or elbow, 3 were followed by early deep wound infections (1.3%). In univariate analyses, factors significantly related to the occurrence of complications included Hispanic ethnicity [relative risk (RR) 1.43, 95% confidence interval (CI) 1.16 to 1.78], and preoperative use of azathioprine (RR 2.13, 95% CI 1.04 to 4.37). Complications were less frequent among patients given methotrexate, but the difference was not significant. Operative blood loss was inversely related to the occurrence of complications. In the multivariate model, the only significant predictors of complications were Hispanic ethnicity (RR 2.86, 95% CI 1.43 to 5.56) and operative blood loss (RR 0.50/liter lost, 95% CI 0.29 to 0.86). Conclusions. We were unable to demonstrate an independent effect of antirheumatic therapy at the time of surgery on the occurrence of postoperative wound complications. Our study suggests that patients with RA of Hispanic ethnicity may be at increased risk of developing postoperative wound complications following orthopedic surgery. Further study is necessary to explain the mechanism of increased complications in this population.

Original languageEnglish (US)
Pages (from-to)1844-1851
Number of pages8
JournalJournal of Rheumatology
Volume22
Issue number10
StatePublished - 1995

Fingerprint

Orthopedics
Rheumatoid Arthritis
Hispanic Americans
Confidence Intervals
Wounds and Injuries
Knee Replacement Arthroplasties
Wound Infection
Hip
Joints
Cellulitis
Azathioprine
Elbow
Methotrexate
Abscess
Sutures
Statistical Factor Analysis
Drainage
Population
Therapeutics

Keywords

  • Arthroplasty
  • Azathioprine
  • Hispanics
  • Methotrexate
  • Rheumatoid arthritis
  • Wound healing

ASJC Scopus subject areas

  • Immunology
  • Rheumatology

Cite this

Risk factors for early wound complications after orthopedic surgery for rheumatoid arthritis. / Escalante, Agustin; Beardmore, T. D.

In: Journal of Rheumatology, Vol. 22, No. 10, 1995, p. 1844-1851.

Research output: Contribution to journalArticle

@article{a985f8c3bbac482ebdbc87ed70710cfc,
title = "Risk factors for early wound complications after orthopedic surgery for rheumatoid arthritis",
abstract = "Objective. To identify risk factors for the occurrence of early wound complications following orthopedic surgery in patients with rheumatoid arthritis (RA). Methods, We reviewed records of patients with RA undergoing joint surgery to identify predictors of the following early postoperative surgical outcomes: (1) prolonged drainage; (2) wound cellulitis; (3) wound dehiscence; (4) suture abscess; and (5) superficial or deep wound infection. Results. During the study, 204 patients with RA underwent 119 total knee replacements, 105 to,tal hip replacements and 143 procedures of other joints, for a total of 367 orthopedic surgeries. A total of 57 complications were observed (15.9{\%}) of which 26 were considered major (7{\%}). Of the 230 total arthroplasties of the hip, knee, shoulder or elbow, 3 were followed by early deep wound infections (1.3{\%}). In univariate analyses, factors significantly related to the occurrence of complications included Hispanic ethnicity [relative risk (RR) 1.43, 95{\%} confidence interval (CI) 1.16 to 1.78], and preoperative use of azathioprine (RR 2.13, 95{\%} CI 1.04 to 4.37). Complications were less frequent among patients given methotrexate, but the difference was not significant. Operative blood loss was inversely related to the occurrence of complications. In the multivariate model, the only significant predictors of complications were Hispanic ethnicity (RR 2.86, 95{\%} CI 1.43 to 5.56) and operative blood loss (RR 0.50/liter lost, 95{\%} CI 0.29 to 0.86). Conclusions. We were unable to demonstrate an independent effect of antirheumatic therapy at the time of surgery on the occurrence of postoperative wound complications. Our study suggests that patients with RA of Hispanic ethnicity may be at increased risk of developing postoperative wound complications following orthopedic surgery. Further study is necessary to explain the mechanism of increased complications in this population.",
keywords = "Arthroplasty, Azathioprine, Hispanics, Methotrexate, Rheumatoid arthritis, Wound healing",
author = "Agustin Escalante and Beardmore, {T. D.}",
year = "1995",
language = "English (US)",
volume = "22",
pages = "1844--1851",
journal = "Journal of Rheumatology",
issn = "0315-162X",
publisher = "Journal of Rheumatology",
number = "10",

}

TY - JOUR

T1 - Risk factors for early wound complications after orthopedic surgery for rheumatoid arthritis

AU - Escalante, Agustin

AU - Beardmore, T. D.

PY - 1995

Y1 - 1995

N2 - Objective. To identify risk factors for the occurrence of early wound complications following orthopedic surgery in patients with rheumatoid arthritis (RA). Methods, We reviewed records of patients with RA undergoing joint surgery to identify predictors of the following early postoperative surgical outcomes: (1) prolonged drainage; (2) wound cellulitis; (3) wound dehiscence; (4) suture abscess; and (5) superficial or deep wound infection. Results. During the study, 204 patients with RA underwent 119 total knee replacements, 105 to,tal hip replacements and 143 procedures of other joints, for a total of 367 orthopedic surgeries. A total of 57 complications were observed (15.9%) of which 26 were considered major (7%). Of the 230 total arthroplasties of the hip, knee, shoulder or elbow, 3 were followed by early deep wound infections (1.3%). In univariate analyses, factors significantly related to the occurrence of complications included Hispanic ethnicity [relative risk (RR) 1.43, 95% confidence interval (CI) 1.16 to 1.78], and preoperative use of azathioprine (RR 2.13, 95% CI 1.04 to 4.37). Complications were less frequent among patients given methotrexate, but the difference was not significant. Operative blood loss was inversely related to the occurrence of complications. In the multivariate model, the only significant predictors of complications were Hispanic ethnicity (RR 2.86, 95% CI 1.43 to 5.56) and operative blood loss (RR 0.50/liter lost, 95% CI 0.29 to 0.86). Conclusions. We were unable to demonstrate an independent effect of antirheumatic therapy at the time of surgery on the occurrence of postoperative wound complications. Our study suggests that patients with RA of Hispanic ethnicity may be at increased risk of developing postoperative wound complications following orthopedic surgery. Further study is necessary to explain the mechanism of increased complications in this population.

AB - Objective. To identify risk factors for the occurrence of early wound complications following orthopedic surgery in patients with rheumatoid arthritis (RA). Methods, We reviewed records of patients with RA undergoing joint surgery to identify predictors of the following early postoperative surgical outcomes: (1) prolonged drainage; (2) wound cellulitis; (3) wound dehiscence; (4) suture abscess; and (5) superficial or deep wound infection. Results. During the study, 204 patients with RA underwent 119 total knee replacements, 105 to,tal hip replacements and 143 procedures of other joints, for a total of 367 orthopedic surgeries. A total of 57 complications were observed (15.9%) of which 26 were considered major (7%). Of the 230 total arthroplasties of the hip, knee, shoulder or elbow, 3 were followed by early deep wound infections (1.3%). In univariate analyses, factors significantly related to the occurrence of complications included Hispanic ethnicity [relative risk (RR) 1.43, 95% confidence interval (CI) 1.16 to 1.78], and preoperative use of azathioprine (RR 2.13, 95% CI 1.04 to 4.37). Complications were less frequent among patients given methotrexate, but the difference was not significant. Operative blood loss was inversely related to the occurrence of complications. In the multivariate model, the only significant predictors of complications were Hispanic ethnicity (RR 2.86, 95% CI 1.43 to 5.56) and operative blood loss (RR 0.50/liter lost, 95% CI 0.29 to 0.86). Conclusions. We were unable to demonstrate an independent effect of antirheumatic therapy at the time of surgery on the occurrence of postoperative wound complications. Our study suggests that patients with RA of Hispanic ethnicity may be at increased risk of developing postoperative wound complications following orthopedic surgery. Further study is necessary to explain the mechanism of increased complications in this population.

KW - Arthroplasty

KW - Azathioprine

KW - Hispanics

KW - Methotrexate

KW - Rheumatoid arthritis

KW - Wound healing

UR - http://www.scopus.com/inward/record.url?scp=0028808362&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028808362&partnerID=8YFLogxK

M3 - Article

C2 - 8991980

AN - SCOPUS:0028808362

VL - 22

SP - 1844

EP - 1851

JO - Journal of Rheumatology

JF - Journal of Rheumatology

SN - 0315-162X

IS - 10

ER -