Patients with systemic lupus erythematosus (SLE) are at a high risk for complications and mortality following major surgery compared with patients without SLE, according to study data published in Lupus.
Investigators abstracted medical record data on infectious and non-infectious complications and 30-day post-surgery mortality in 382 adult patients with and without SLE. Patients with SLE (n=191) were matched 1:1 with patients without SLE or other connective tissue disorders (n=191) by age, gender, and surgery type. SLE clinical characteristics at diagnosis and at time of surgery were also extracted, including disease duration; presence of secondary antiphospholipid syndrome (APS); use of oral anticoagulants or aspirin; and treatment at time of surgery, including immunosuppressant dose. Various SLE comorbidities were additionally captured, including obesity, smoking status, arterial hypertension, and diabetes.
Postoperative complications occurred in 43% of patients with SLE compared with 30% of patients without SLE (P =.01). Escherichia coli infections and acute kidney injury were the most frequent infectious and non-infectious complications, respectively, in controls and patients with SLE. In addition, 6% of patients with SLE died in the 30 days following surgery compared with 1% of patients without SLE (P =.02).
Infectious complications in patients with SLE were associated (P <.05) with prednisone use (odds ratio [OR], 1.81; 95% CI, 1.13-2.90), anemia (OR, 2.43; 95% CI, 1.45-4.08), hypoalbuminemia (OR, 2.58; 95% CI, 1.55-4.30), and lymphopenia (OR, 2.43, 95% CI 1.52-3.89). Variables predictive (P <.05) of non-infectious complications in patients with SLE included anemia (OR, 1.93; 95% CI, 1.03-3.64) and hypoalbuminemia (OR, 2.11; 95% CI, 1.16-3.86). Complications of any kind in patients with SLE were associated with higher disease activity (OR, 1.10; 95% CI, 1.01-1.20), nephritis (OR, 10.08; 95% CI 1.21-83.63), aspirin use (OR, 2.68; 95% CI, 1.19-6.02; P =.01), low C3 levels (OR, 2.00; 95% CI, 1.06-3.80), anemia (OR, 2.68; 95% CI, 1.39-5.18), hypoalbuminemia (OR, 3.49; 95% CI, 1.83-6.66) and lymphopenia (OR, 2.36; 95% CI 1.30-4.26). According to multivariate regression analyses, hypoalbuminemia, anemia, lymphopenia, and aspirin use remained significant independent risk factors for post-surgery complications in patients with SLE.
These data identify and characterize the elevated risk for post-surgery complications in patients with SLE. According to these data, SLE disease activity, comorbidities, and additional clinical characteristics should be assessed prior to surgery to minimize morbidity risk.
Quintanilla-González L, Torres-Villalobos G, Hinojosa-Azaola A. Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery [published online September 5, 2018]. Lupus. doi:10.1177/0961203318799188