Patients with rheumatoid arthritis (RA) have a high overall incidence of mortality, primarily due to cardiovascular complications. But RA patients are not at increased risk for post-surgery cardiovascular complications or death compared to non-RA patients with similar clinical characteristics, a study titled “The Association Between Rheumatoid Arthritis and Adverse Postoperative Outcomes: A Retrospective Analysis,” and published in Anesthesia & Analgesia, reported.
The study also showed no evidence that RA is associated with an increased risk of other inflammation-related complications. “We expected to find an increased risk of cardiovascular, thromboembolic, and microcirculatory complications in RA patients; our results did not support this association,” Dr. Alparslan Turan and colleagues at the Cleveland Clinic wrote, according to a news release.
Researchers used a large hospital database to identify two groups of patients — in Arizona, California, Florida, Iowa, Maryland, Michigan, and New Jersey — who underwent surgery between 2009-10. Both groups were matched for demographic characteristics and each group comprised 66,886 patients: one group with a diagnosis of RA and one group without RA. One thousand ninety-five (1.64%) of the matched rheumatoid arthritis discharges and one thousand and six (1.50%) of the matched controls had in-hospital cardiovascular complications.
Dr. Turan and colleagues compared rates of cardiovascular complications, such as cardiac arrest and heart attack, in patients with and without RA and tested the hypothesis that rheumatoid arthritis would be independently associated with increased postoperative cardiovascular complications, and, specifically, with increased thromboembolic complications, microcirculatory complications, and mortality. The association was suspected because, as the authors noted, surgery can provoke the release of inflammatory mediators.
The results showed no significant difference between groups in any of these adverse outcomes. Moreover, there were no significant differences in the odds of in-hospital thromboembolic complications (1.03 [0.93–1.15]; P = 0.42), in-hospital microcirculatory complications (0.94 [0.86–1.01]; P = 0.03), or in-hospital mortality (1.11 [0.98–1.25]; P = 0.04)
Further analysis revealed that small differences in the risk of adverse outcomes might be associated with the presence of chronic heart disease in patients with RA. However, these differences were not significant.
RA was present in 1.27 percent of patients, corroborating the 1 percent to 5 percent prevalence range reported by previous studies. Concerning the finding that RA was not associated with an increased risk for postoperative cardiovascular complications, Dr. Turan and coauthors wrote, “This result is surprising since RA provokes substantial persistent inflammation, which is believed to cause premature development of atherosclerosis, along with venous and arterial thromboembolism.”
While admitting some data limitations, the researchers noted, “By far this is the largest study of RA and perioperative cardiovascular events.”
These findings might offer important insights on the risks of surgery in RA patients, including decisions as to whether patients are clinically apt to undergo such surgeries. However, the authors noted that the lack of difference in mortality might be related with the fact that this risk is determined by other clinical features than by RA itself.