Session Information
Session Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment: Complications of Systemic Lupus Erythematosus
Session Type: Abstract Submissions (ACR)
Background/Purpose: Total Hip Arthroplasty (THA) is the most frequent orthopedic procedure performed in lupus (SLE) patients. Whether SLE patients have higher rates of complications after THA than osteoarthritis (OA) patients is unknown. This study compares 6 month adverse event (AE) rates in SLE to matched OA controls.
Methods: Patients enrolled in our institution’s THA registry from 2007-2011 were eligible. SLE was identified by ICD-9 code 710.0, and the diagnosis confirmed by chart review. AEs were identified by chart review and self-report questionnaire. SLE patients were matched 2:1 with OA controls by age, gender, year of surgery and hip resurfacing vs. THA. Fractures and other autoimmune diseases were excluded. Baseline characteristics of SLE and OA patients were compared and regression analysis performed to identify independent predictors of AEs.
Results: 58 SLE THA were matched to 116 OA controls. Mean age was 52 years (SLE) vs. 50 years (OA) (p-value=0.57), 90.5% were female. Pre-operative corticosteroid use and perioperative “stress dose” steroids were more common in SLE than OA (44.8% vs. 0.9%; p-value<0.0001 and 53.7% vs. 1.7%, %; p-value<0.0001, respectively). 47.4% of SLE had Charlson-Deyo co-morbidity scores (excluding SLE) ≥1 vs. 13.1% of OA (p-value<0.0001). Spinal/epidural was more common in OA (98.3% OA vs. 82.5% SLE; p-value<0.0001); more SLE received spinal alone (14% SLE vs. 0.9% OA; p-value<0.0001). There was no difference in operative time (86.9 minutes SLE vs. 84.4 OA; p-value=0.65). Length of stay was longer in SLE (6.0 days vs. 4.7; p-value=0.0008). Within 6 months after surgery, SLE had more falls (10.3% vs. 1.7%; p-value=0.02), DVTs (5.2% vs. 0%; p-value=0.036), acute renal disease (8.6% vs. 0%; p-value=0.004), superficial wound infections (6.9% vs. 0.9%, p-value=0.043) and revision surgeries (5.2% vs. 0%; p-value=0.036). Overall, 50% of SLE had any AE vs. 19.8% OA (p-value<0.0001) and 34.5% of SLE had a major AE vs. 10.3% OA (p-value=0.0001). In a multiple logistic regression analysis controlling for comorbidities and anesthesia type, SLE had an increased risk of AEs compared to OA (OR 3.77; 95% CI 1.74-8.16). Interestingly, co-morbidity scores were not significantly associated with risk of AE (Table 1). Among SLE there were no significant differences in AE rates between those taking pre-operative corticosteroids vs. none or those receiving perioperative stress-dose steroids vs. none.
Conclusion: SLE is an independent risk factor for AE after THA. SLE patients had higher rates of fall, acute renal disease, DVT, infection, revision surgery, and longer lengths of stay than matched OA controls. AE rates within SLE were not significantly associated with steroid use. Further research is needed to better understand the causes of increased AE risk in SLE patients.
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Table 1: Multivariate Logistic regression* A) Any Adverse Event |
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Odds Ratio |
95% Confidence Limits |
P-value |
|
|
SLE vs. OA |
3.77 |
1.74-8.16 |
0.0008 |
|
Charlson-Deyo Comorbidity Index** >=1 vs. 0 |
1.69 |
0.76-3.76 |
0.20 |
|
Epidural Block vs. no |
1.29 |
0.35-4.73 |
0.71 |
|
B) Any Major Adverse Event: ( Major AE= DVT, PE, fall, fracture, additional surgery, acute renal disease, cardiac event– MI, cardiac event–dysrhythmia, deep surgical site infection, bleeding event requiring transfusion, pneumonia, neuropathy, death) |
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|
Odds Ratio |
95% Confidence Limits |
P-value |
|
|
SLE vs. OA |
3.70 |
1.52-8.89 |
0.004 |
|
Charlson-Deyo Comorbidity Index** >=1 vs. 0 |
1.82 |
0.75-4.41 |
0.19 |
|
Epidural Block vs. no |
0.87 |
0.22-3.35 |
0.84 |
|
C) Any Minor Adverse Event: (Minor Adverse Event= superficial infection, ecchymosis, erythema, incision site drainage, spinal headache, poor wound healing) |
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Odds Ratio |
95% Confidence Limits |
P-value |
|
|
SLE vs. OA |
3.54 |
1.41-8.91 |
0.007 |
|
Charlson-Deyo Comorbidity Index** >=1 vs. 0 |
1.19 |
0.46-3.12 |
0.72 |
|
Epidural Block vs. no |
1.91 |
0.37-9.86 |
0.44 |
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* All models control for disease (SLE vs. OA), comorbidities and type of anesthesia **Charlson-Deyo comorbidity index was calculated by excluding SLE |
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This study was supported by the Clinical Translational Science Center (CTSC) (UL1-TR000457-06) and the HSS Medical Student Research Fellowship.
Disclosure:
J. Roberts,
None;
L. A. Mandl,
None;
E. Su,
None;
D. J. Mayman,
None;
M. P. Figgie,
None;
A. Fein,
None;
Y. Y. Lee,
None;
U. Shah,
None;
S. M. Goodman,
None.
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