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Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty
- Source :
- Arthritis Care & Research. 69:1845-1854
- Publication Year :
- 2017
- Publisher :
- Wiley, 2017.
-
Abstract
- The optimal timing of tumor necrosis factor antagonists before elective surgery is unknown. This study evaluated the association between infliximab timing and serious infection after elective hip or knee arthroplasty.A retrospective cohort study evaluated US Medicare patients with rheumatoid arthritis, inflammatory bowel disease, psoriasis, psoriatic arthritis, or ankylosing spondylitis who received infliximab within 6 months of elective knee or hip arthroplasty from 2007 to 2013. Propensity-adjusted analyses examined whether infliximab stop timing (time between the most recent infusion and surgery) was associated with hospitalized infection within 30 days or prosthetic joint infection (PJI) within 1 year.Hospitalized infection within 30 days occurred after 270 of 4,288 surgeries (6.3%). Infliximab stop timing4 weeks versus 8-12 weeks was not associated with an increase in infection within 30 days (propensity-adjusted odds ratio [OR] 0.90 [95% confidence interval (95% CI) 0.60-1.34]). The rate of PJI was 2.9 per 100 person-years and was not increased in patients with stop timing4 weeks versus 8-12 weeks (hazard ratio [HR] 0.98 [95% CI 0.52-1.87]). Glucocorticoid dosage10 mg/day was associated with increased risk of 30-day infection (OR 2.11 [95% CI 1.30-3.40]) and PJI (HR 2.70 [95% CI 1.30-5.60]). Other risk factors for infection included elderly age, comorbidities, revision surgery, and previous hospitalized infection.Administering infliximab within 4 weeks of elective knee or hip arthroplasty was not associated with a higher risk of short- or long-term serious infection compared to withholding infliximab for longer time periods. Glucocorticoid use, especially10 mg/day, was associated with an increased infection risk.
- Subjects :
- Male
Time Factors
Knee Joint
Arthroplasty, Replacement, Hip
medicine.medical_treatment
Kaplan-Meier Estimate
0302 clinical medicine
Risk Factors
Odds Ratio
030212 general & internal medicine
Prosthesis-Related Infection
Arthroplasty, Replacement, Knee
Treatment Outcome
Elective Surgical Procedures
Antirheumatic Agents
Female
Hip Joint
Knee Prosthesis
Elective Surgical Procedure
medicine.drug
musculoskeletal diseases
medicine.medical_specialty
Prosthesis-Related Infections
Medicare
Article
Drug Administration Schedule
Immunocompromised Host
03 medical and health sciences
Psoriatic arthritis
Rheumatology
medicine
Humans
Elective surgery
Propensity Score
Glucocorticoids
Aged
Proportional Hazards Models
Retrospective Studies
030203 arthritis & rheumatology
Chi-Square Distribution
business.industry
Retrospective cohort study
Perioperative
medicine.disease
Arthroplasty
Infliximab
United States
Surgery
Logistic Models
Multivariate Analysis
Hip Prosthesis
business
Subjects
Details
- ISSN :
- 21514658 and 2151464X
- Volume :
- 69
- Database :
- OpenAIRE
- Journal :
- Arthritis Care & Research
- Accession number :
- edsair.doi.dedup.....a0de3cf88c81b74b64f807db53a57bbb