2023 ISAKOS Biennial Congress ePoster
Postoperative Flares and Peri-Arthroscopic Management of Immunosuppressive Medications in Patients with Rheumatic Disease
Kinjal Vasavada, BA UNITED STATES
Dhruv S Shankar, BS, New York UNITED STATES
Amanda Avila, MPH UNITED STATES
Charles C Lin, MD, New York, New York UNITED STATES
David Marulanda, Pittsburgh, PA UNITED STATES
Laith M. Jazrawi, MD, New York, NY UNITED STATES
Jonathan Samuels, MD, New York, New York UNITED STATES
NYU Langone Health Department of Orthopedic Surgery, New York, New York, UNITED STATES
FDA Status Not Applicable
Summary
To determine the rate and characteristics of postoperative flares in rheumatic disease patients undergoing arthroscopic surgery, and the role of perioperative immunosuppression (IS) management in preventing or provoking these exacerbations.
ePosters will be available shortly before Congress
Abstract
Introduction
To determine the rate and characteristics of postoperative flares in rheumatic disease patients undergoing arthroscopic surgery, and the role of perioperative immunosuppression (IS) management in preventing or provoking these exacerbations.
Methods
We conducted a retrospective review of arthroscopic surgeries in patients with rheumatologic disease over 11 years. Patients taking IS at baseline and those without were matched 1:1 using propensity scores on age, sex, rheumatic disease type, and procedure complexity. Patients taking IS at baseline were sub-divided into those remaining on IS perioperatively versus those who held IS before surgery. Multivariable logistic regression identified risk factors for postoperative flares for the three IS groups, and survival analysis was used to compare the probability of remaining flare- free up to 12 weeks postoperatively.
Results
After matching, 428 patients (214 on baseline IS, 214 not on baseline IS) were included, with 110 on baseline IS remaining on it perioperatively. Rates of postoperative flares were similar for those staying on vs holding their baseline IS (9.1% vs 9.6%) but flares were less frequent in patients not on baseline IS (1.9%). Patients who remained on perioperative IS did not have significantly less flares compared to patients taken off perioperative IS (OR 0.764 [0.267, 2.181]; p = 0.61). Patients not on baseline IS had a significantly higher probability of remaining flare-free up to 12 weeks (p = 0.004).
Discussion And Conclusion
Rheumatic disease patients who hold IS medication before undergoing arthroscopy do not increase their risk of flaring their autoimmune disease. Those not taking any IS at baseline have a much lower risk of post-arthroscopic flaring, though as a group they might harbor less of an autoimmune burden. Given the overall low observed rates of postoperative infection and complications among our cohort, the feared trade-off between infection risk and flare risk may not hold true in arthroscopy.