ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2503

Impact of Tobacco Smoking on 1-Year Mortality Following Total Hip and Total Knee Arthroplasty Among Rheumatoid Arthritis Patients – a Danish Cohort Study Using Nationwide Health Care Registers

René Cordtz1,2, Laerke Bech-Illum3, Daniel Prieto-Alhambra4, Pil Hoejgaard3,5, Kristian Zobbe3,6, Nina Imbæk3 and Lene Dreyer7, 1Center for Rheumatology and Spine Diseases, Gentofte-Rigshospitalet, Hellerup, Denmark, 2The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark, 3Center for Rheumatology and Spine Diseases - Gentofte, Rigshospitalet, Hellerup, Denmark, 4Internal Medicine and Primary Care, URFOA-IMIM, Parc de Salut Mar; Idiap Jordi Gol i Gurina-Institut Català de la Salut; Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK, Barcelona, Spain, 5The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark, 6The Parker Institute, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Copenhagen, Denmark, 7Departments of Rheumatology and Clinical Medicine, Aalborg University Hospital and Aalborg University, 9000 Aalborg, Denmark

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Tobacco smoking and rheumatoid arthritis (RA) are independent risk factors for short-term complications following total hip and total knee arthroplasty (THA/TKA). We aimed to investigate the impact of smoking on 1-year post-operative mortality in RA patients undergoing THA/TKA.

Methods:

Nationwide register-based cohort study from Denmark from 2000-14. The study population was RA patients (diagnosed according to either ACR 1987 or ACR/EULAR 2010 criteria) registered in the Danish rheumatology register (DANBIO) and in the linked Danish Hip or Knee Arthroplasty Registers with a first elective THA/TKA surgery. Information on smoking status (exposure), DAS28, HAQ-DI, biological and conventional synthetic DMARD (bDMARD and csDMARD) and glucocorticoid treatment within 90 days preceding surgery (confounders) was gathered from DANBIO. Information on pre-existing comorbidities and mortality data (outcome) was obtained by linkage to the Danish National Patient Register and the Civil Registration System. Using multivariable Cox proportional hazards models, we calculated hazard ratios (HR) for death during the first year following surgery among patients who at the time of surgery were active and previous smokers, respectively, compared with never-smokers. We used multiple imputation for missing information on smoking, DAS28 and HAQ-DI.

Results:

We identified 1,946 RA patients undergoing an elective THA/TKA with available smoking status for 1,092 patients: 255 (24 %) current, 417 (39 %) ex- and 420 (37 %) never smokers (Table). Compared with never smokers, current smokers were more likely to be males, treated with glucocorticoids, have COPD and ischemic heart disease. During the first year post-operatively, 24 patients died. Current smokers had increased HRs for death in uni- and multivariable analyses: adjusted HR 3.33 (95%CI 0.84-13.20) compared with never smokers. Similar results were observed in complete case and imputed analyses.

Conclusion:

We found a 3-fold borderline significant increased 1-year mortality risk among RA patients who were active tobacco smokers at the time of elective THA/TKA surgery. Considering the increased risk of death associated with RA by itself, these results emphasize the importance of smoking abstinence/ cessation prior to major surgery in this vulnerable group of patients.

Table. Number of patients, demographics, pre-surgical characteristics and results of regression analyses on 1-year mortality risk in current, previous and never smoking rheumatoid arthritis (RA) patients with elective total hip or total knee arthroplasty.

Current smoker

Previous smoker

Never smoker

p-value*

Number of patients before imputation,
% of cohort

257 (24)

423 (39)

402 (37)

Mean % of patients after multiple imputation

24

40

36

Female (%)

173 (67)

285 (67)

333 (83)

<0.001

Age at surgery (mean (sd))

61.4 (11.1)

65.7 (9.8)

62.1 (12.5)

<0.001

Age at RA diagnosis (mean (sd))

51.9 (13.2)

55.9 (13.4)

50.8 (15.4)

<0.001

Seropositive RA (%)

226 (88)

384 (91)

351 (87)

0.109

DAS28-CRP (mean (sd))

3.7 (1.3)

3.6 (1.4)

3.7 (1.4)

0.235

HAQ-DI (mean (sd))

1.20 (0.77)

1.12 (0.76)

1.23 (0.74)

0.001

Treated with bDMARD (%)

68 (27)

72 (17)

94 (23)

<0.001

Treated with csDMARD (%)

105 (41)

156 (37)

159 (40)

0.276

Treated with MTX (%)

71 (28)

114 (27.0)

120 (29.9)

0.526

Treated with glucocorticoids (%)

46 (18)

58 (14)

47 (12)

0.005

History of hospitalization due to infection (%)

70 (27)

117 (28)

102 (25)

0.559

Diabetes mellitus (%)

13 (5)

30 (7)

27 (7)

0.796

Chronic obstructive pulmonary disease (%)

22 (9)

35 (8)

20 (5)

0.008

Ischemic heart disease (%)

12 (5)

30 (7)

9 (2)

0.001

Hazard ratio for death by smoking status (complete case analysis, non-imputed data)

Number of deaths

5

4

2

 

Univariate non-imputed, HR (95%CI)

3.93 (0.76-20.26)

1.88 (0.34-10.27)

1 (Ref)

 

Multivariable model 1 ¤, HR (95%CI)

3.87 (0.73-20.35)

1.54 (0.28-8.49)

1 (Ref)

 

Multivariable model 2 ¤¤, HR (95%CI)

4.05 (0.67-24.35)

2.22 (0.38-13.07)

1 (Ref)

 

Hazard ratio for death by smoking status (complete cohort, imputed data)

Number of deaths

12

7

5

 

Univariate analysis, HR (95%CI)

3.45 (0.88-13.49)

1.93 (0.43-8.62)

1 (Ref)

 

Multivariable model 1 ¤, HR (95%CI)

3.46 (0.87-13.74)

1.53 (0.34-6.94)

1 (Ref)

 

Multivariable model 2 ¤¤, HR (95%CI)

3.33 (0.84-13.20)

1.70 (0.36-7.95)

1 (Ref)

 

* Using t-test and chi-square as appropriate.  ¤: Adjusted for age at surgery, sex, biological DMARD, conventional synthetic DMARD and glucocorticoid treatment (yes/no) within 90 days prior to surgery.   ¤¤: Adjusted for age at surgery, sex, biological DMARD, conventional synthetic DMARD and glucocorticoid treatment (yes/no) within 90 days prior to surgery, DAS28 and HAQ-DI.   Abbreviations: 95%CI, 95 % confidence intervals; bDMARD, biological DMARD, csDMARD, conventional synthetic DMARD; DAS28-CRP, disease activity score using the 28 joint-count and C-reactive protein; HAQ-DI, health assessment questionnaire disability index; HR, hazard ratio; MTX, methotrexate; sd, standard deviation.

 

Disclosure: R. Cordtz, None; L. Bech-Illum, None; D. Prieto-Alhambra, None; P. Hoejgaard, None; K. Zobbe, None; N. Imbæk, None; L. Dreyer, Eli Lilly and Co., 8.

To cite this abstract in AMA style:

Cordtz R, Bech-Illum L, Prieto-Alhambra D, Hoejgaard P, Zobbe K, Imbæk N, Dreyer L. Impact of Tobacco Smoking on 1-Year Mortality Following Total Hip and Total Knee Arthroplasty Among Rheumatoid Arthritis Patients – a Danish Cohort Study Using Nationwide Health Care Registers [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/impact-of-tobacco-smoking-on-1-year-mortality-following-total-hip-and-total-knee-arthroplasty-among-rheumatoid-arthritis-patients-a-danish-cohort-study-using-nationwide-health-care-registers/. Accessed .

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