Adverse outcomes after major surgery in patients with systemic lupus erythematosus: A nationwide population-based study

Jui-An Lin, Chien-Chang Liao, Yi Jui Lee, Chih-Hsiung Wu, Wen Qi Huang, Ta-Liang Chen

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objectives: To investigate the postoperative adverse outcomes among surgical patients with preoperative systemic lupus erythematosus (SLE) in a nationwide population-based study. Methods: We used Taiwan's National Health Insurance Research Database to identify 4321 surgical inpatients with SLE and 17 284 sex- and age-matched controls receiving major surgery. Sociodemographic characteristics, preoperative comorbidities, postoperative 30-day in-hospital major complications and mortality were analysed among surgical patients with and without SLE. Results: Surgical patients with SLE had a higher prevalence of preoperative coexisting medical conditions and postoperative major complications. The OR of 30-day postoperative mortality for surgical patients with SLE was 1.71 (95% CI 1.09 to 2.67) after adjustment. Surgical patients who had received more recent (within 6 months) preoperative SLE-related inpatient care had higher risks of 30-day postoperative acute renal failure (OR=7.23, 95% CI 4.52 to 11.6), pneumonia (OR=2.60, 95% CI 1.82 to 3.72), pulmonary embolism (OR=4.86, 95% CI 1.20 to 19.7), septicaemia (OR=3.43, 95% CI 2.48 to 4.74), stroke (OR=2.01, 95% CI 1.38 to 2.92), overall complications (OR=2.30, 95% CI 1.89 to 2.80) and 30-day postoperative mortality (OR=2.39, 95% CI 1.28 to 4.45) than surgical patients without SLE. SLE-related preoperative steroid injections showed a dose-dependent relationship with postoperative complications and mortality. Conclusions: SLE significantly increased the risks of surgical patients for overall major complications and mortality after major surgery. Our findings demonstrated the need for integrated care and revised protocols for perioperative management to improve outcomes for surgical patients with SLE.

Original languageEnglish
Pages (from-to)1646-1651
Number of pages6
JournalAnnals of the Rheumatic Diseases
Volume73
Issue number9
DOIs
Publication statusPublished - 2014

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Systemic Lupus Erythematosus
Surgery
Health insurance
Population
Steroids
Mortality
Inpatients
National Health Programs
Pulmonary Embolism
Taiwan
Acute Kidney Injury
Comorbidity
Sepsis
Pneumonia
Stroke
Databases
Injections
Research

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Allergy

Cite this

Adverse outcomes after major surgery in patients with systemic lupus erythematosus : A nationwide population-based study. / Lin, Jui-An; Liao, Chien-Chang; Lee, Yi Jui; Wu, Chih-Hsiung; Huang, Wen Qi; Chen, Ta-Liang.

In: Annals of the Rheumatic Diseases, Vol. 73, No. 9, 2014, p. 1646-1651.

Research output: Contribution to journalArticle

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abstract = "Objectives: To investigate the postoperative adverse outcomes among surgical patients with preoperative systemic lupus erythematosus (SLE) in a nationwide population-based study. Methods: We used Taiwan's National Health Insurance Research Database to identify 4321 surgical inpatients with SLE and 17 284 sex- and age-matched controls receiving major surgery. Sociodemographic characteristics, preoperative comorbidities, postoperative 30-day in-hospital major complications and mortality were analysed among surgical patients with and without SLE. Results: Surgical patients with SLE had a higher prevalence of preoperative coexisting medical conditions and postoperative major complications. The OR of 30-day postoperative mortality for surgical patients with SLE was 1.71 (95{\%} CI 1.09 to 2.67) after adjustment. Surgical patients who had received more recent (within 6 months) preoperative SLE-related inpatient care had higher risks of 30-day postoperative acute renal failure (OR=7.23, 95{\%} CI 4.52 to 11.6), pneumonia (OR=2.60, 95{\%} CI 1.82 to 3.72), pulmonary embolism (OR=4.86, 95{\%} CI 1.20 to 19.7), septicaemia (OR=3.43, 95{\%} CI 2.48 to 4.74), stroke (OR=2.01, 95{\%} CI 1.38 to 2.92), overall complications (OR=2.30, 95{\%} CI 1.89 to 2.80) and 30-day postoperative mortality (OR=2.39, 95{\%} CI 1.28 to 4.45) than surgical patients without SLE. SLE-related preoperative steroid injections showed a dose-dependent relationship with postoperative complications and mortality. Conclusions: SLE significantly increased the risks of surgical patients for overall major complications and mortality after major surgery. Our findings demonstrated the need for integrated care and revised protocols for perioperative management to improve outcomes for surgical patients with SLE.",
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AB - Objectives: To investigate the postoperative adverse outcomes among surgical patients with preoperative systemic lupus erythematosus (SLE) in a nationwide population-based study. Methods: We used Taiwan's National Health Insurance Research Database to identify 4321 surgical inpatients with SLE and 17 284 sex- and age-matched controls receiving major surgery. Sociodemographic characteristics, preoperative comorbidities, postoperative 30-day in-hospital major complications and mortality were analysed among surgical patients with and without SLE. Results: Surgical patients with SLE had a higher prevalence of preoperative coexisting medical conditions and postoperative major complications. The OR of 30-day postoperative mortality for surgical patients with SLE was 1.71 (95% CI 1.09 to 2.67) after adjustment. Surgical patients who had received more recent (within 6 months) preoperative SLE-related inpatient care had higher risks of 30-day postoperative acute renal failure (OR=7.23, 95% CI 4.52 to 11.6), pneumonia (OR=2.60, 95% CI 1.82 to 3.72), pulmonary embolism (OR=4.86, 95% CI 1.20 to 19.7), septicaemia (OR=3.43, 95% CI 2.48 to 4.74), stroke (OR=2.01, 95% CI 1.38 to 2.92), overall complications (OR=2.30, 95% CI 1.89 to 2.80) and 30-day postoperative mortality (OR=2.39, 95% CI 1.28 to 4.45) than surgical patients without SLE. SLE-related preoperative steroid injections showed a dose-dependent relationship with postoperative complications and mortality. Conclusions: SLE significantly increased the risks of surgical patients for overall major complications and mortality after major surgery. Our findings demonstrated the need for integrated care and revised protocols for perioperative management to improve outcomes for surgical patients with SLE.

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