Lupus diagnosis warns of postoperative risks
medwireNews: Patients with systemic lupus erythematosus (SLE) are at high risk for a poor outcome from surgery, highlights research published in the Annals of Rheumatic Disease.
"Our findings demonstrated the need for integrated care and revised protocols for perioperative management to improve outcomes for surgical patients with SLE," say Ta-Liang Chen (Taipei Medical University Hospital, Taiwan) and co-authors.
Overall, 0.8% of 4321 Taiwanese inpatients with SLE died within 30 days of surgery compared with just 0.4% of 17,284 age- and gender-matched patients without the autoimmune disorder, giving an odds ratio of 1.71 after adjusting for comorbidity, type of surgery, and other confounders.
Patients with SLE were also 1.29 times more likely to experience a major postoperative complication than controls (8.9 vs 6.6%).
The likelihood of a poor outcome was especially high among patients who had been hospitalized for SLE-related issues in the 6 months before their surgery, with an odds ratio (OR) for 30-day mortality of 2.39 and an OR for any postoperative complication of 2.30.
These patients were particularly at risk for developing acute renal failure (OR=7.23), pneumonia (OR=2.60), pulmonary embolism (OR=4.86), septicemia (OR=3.43), or stroke (OR=2.01) within 30 days of surgery.
Further analysis revealed a dose-dependent relationship between number of steroid injections in the 2 years before surgery and the risk for an adverse outcome. Compared with SLE patients not given steroid injections, patients given three or more injections had a significantly greater adjusted risk for 30-day mortality (OR=2.86) or postoperative complication (OR=2.73).
Adverse outcomes influenced by steroid therapy included acute myocardial infarction (OR=2.90), acute renal failure (OR=5.15), pneumonia (OR=3.59), and septicemia (OR=4.23).
"Steroid injections before, but not during, hospitalisation for index surgery in our study mainly reflected SLE severity and helped to exclude the impact of steroid-induced postoperative complications," the researchers explain.
They therefore conclude: "By evaluating the history of prior hospitalisations and further stratifying the frequency of steroid injections, postoperative risks can be easily assessed and predicted.
"The results also provide clinical information that will help to improve the quality of perioperative care and thus reduce postoperative adverse events for this specific population."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Lynda Williams, Senior medwireNews Reporter