Perioperative Management of Patients with Connective Tissue Disease

Goodman, Susan M.; Figgie, Mark P.; MacKenzie, C. Ronald

doi:10.1007/s11420-010-9180-1

Cited by 19 publications

(12 citation statements)

References 37 publications

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“…If the patient has the capacity of at least 4 MET (walking at 3–4 miles per hour) without cardiovascular symptoms, then they are far less likely to suffer from cardiovascular incidents (Fleisher et al 2014). Risk assessment can also be carried out via use of imaging techniques such as a stress echocardiogram (Goodman et al 2011). This is especially vital in patients who have a low exercise tolerance capacity (Goodman et al 2011).…”

Section: Preoperative Evaluationmentioning

confidence: 99%

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Perioperative management of patients with rheumatoid arthritis undergoing orthopaedic surgery

Agarwal

Kamaraj

McDonnell

et al. 2019

Journal of Perioperative Practice

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Rheumatoid arthritis is an autoimmune disease which is characterised by systemic inflammation. In the recent decades, the advent of disease modifying anti-rheumatic drugs have reduced the need for orthopaedic procedures. However, there are numerous patients in which pharmacological treatment fails and these patients require surgical intervention. Complications can arise due to the underlying pathology and multitude of medications these patients can be on, specifically increased infection rates due to use of immunosuppressive agents. An understanding into the disease itself, as well as perioperative management, may improve overall patient outcomes and prevent future complications.

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Section: Preoperative Evaluationmentioning

confidence: 99%

“…Risk assessment can also be carried out via use of imaging techniques such as a stress echocardiogram (Goodman et al 2011). This is especially vital in patients who have a low exercise tolerance capacity (Goodman et al 2011).…”

Section: Preoperative Evaluationmentioning

confidence: 99%

Perioperative management of patients with rheumatoid arthritis undergoing orthopaedic surgery

Agarwal

Kamaraj

McDonnell

et al. 2019

Journal of Perioperative Practice

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“…Careful assessment is necessary to ensure the optimal functional outcome 15 In addition, cervical spine involvement, frequently present in carefully screened preoperative RA patients, 16 may complicate airway management, as instability will increase the risk of intubation when general anesthesia is planned. A critical aspect of planning arthroplasty for the RA patient is the consideration of the mechanical impact of affected contiguous joints.…”

Section: Polyarticular Diseasementioning

confidence: 99%

Rheumatoid Arthritis

Goodman

2013

Journal of Clinical Rheumatology

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The role of total joint replacement surgery remains significant in the contemporary management of patients with rheumatoid arthritis (RA), despite the impact of potent biologic and synthetic disease-modifying drugs. Patients with RA have a systemic polyarticular disease, with extra-articular manifestations such as anemia as well as specific comorbidities such as cardiovascular disease, which require careful preoperative assessment for optimal outcomes and fewer adverse events. This review describes the important preoperative considerations taken to prepare a patient with RA for total hip and total knee replacement surgery.

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“…One particular population that has not been widely studied with respect to arthroplasty are patients with idiopathic inflammatory myopathies (IIM), a group of four rare, systemic autoimmune disorders [dermatomyositis (DM), polymyositis (PM), inclusion body myopathy, and autoimmune necrotizing myopathy] that share a number of clinical characteristics[ 5 - 7 ]. IIM patients have baseline increased risk of deep vein thromboses and death[ 5 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is unclear whether IIM directly contributes to joint degeneration[ 6 , 7 ]. High-dose corticosteroids are also often necessary to control major manifestations of IIM, which may result in osteonecrosis and eventual collapse and destruction of joints[ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Dermatomyositis and polymyositis in total hip arthroplasty

Rosas¹,

Schallmo²,

Gowd³

et al. 2021

WJO

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BACKGROUND Idiopathic inflammatory myopathies (IIM) are systemic autoimmune disorders such as dermatomyositis (DM), polymyositis (PM), inclusion body myopathy, and autoimmune necrotizing myopathy that, similar to osteoarthritis, affect quality of life and activities of daily living. Moreover, these patients are often burdened with chronic pain and disability; however, the outcomes and risk of total hip arthroplasty (THA) in this patient population remain unclear. AIM To evaluate 90-d complications and costs in patients with these conditions. METHODS A retrospective case control study was designed by accessing data from the Medicare dataset available on the PearlDiver server. Patients with IIM, here, those with DM and PM were matched based on possible confounding variables to a cohort without these diseases and with the same 10-year risk of mortality as defined by the Charlson Comorbidity Index Score (CCI). Univariate and multivariate analysis were performed to evaluate complications and t-tests to evaluate 90-d Medicare reimbursements as markers of costs after THA. RESULTS The total sample was 1090 patients with each cohort comprised of 545. Females were 74.9% of the population. The mean CCI was 5.89 (SD 2.11). Those with IIM had increased rates of pneumonia [odds ratio (OR) 1.45, P < 0.001] and pulmonary embolism (OR 1.46, P = 0.035) and decreased hematoma risks (OR 0.58, P = 0.00). 90-d costs were on average $1411 greater for those with IIM yet not significantly different ( P = 0.034). CONCLUSION Patients with IIM have an increased 90-d rate of pneumonia and pulmonary embolism concomitant with a decreased hematoma rate consistent with their pro-coagulatory state. Further attention to increased resource utilization in these patients is also warranted.

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Perioperative Management of Patients with Connective Tissue Disease

Cited by 19 publications

References 37 publications

Perioperative management of patients with rheumatoid arthritis undergoing orthopaedic surgery

Perioperative management of patients with rheumatoid arthritis undergoing orthopaedic surgery

Rheumatoid Arthritis

Dermatomyositis and polymyositis in total hip arthroplasty

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