Dr. Wasko has received consulting fees from Centocor (less than $10,000).
Perioperative all-cause mortality and cardiovascular events in patients with rheumatoid arthritis: Comparison with unaffected controls and persons with diabetes mellitus
Version of Record online: 27 JUL 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 64, Issue 8, pages 2429–2437, August 2012
How to Cite
Yazdanyar, A., Wasko, M. C., Kraemer, K. L. and Ward, M. M. (2012), Perioperative all-cause mortality and cardiovascular events in patients with rheumatoid arthritis: Comparison with unaffected controls and persons with diabetes mellitus. Arthritis & Rheumatism, 64: 2429–2437. doi: 10.1002/art.34428
- Issue online: 27 JUL 2012
- Version of Record online: 27 JUL 2012
- Accepted manuscript online: 21 FEB 2012 02:35PM EST
- Manuscript Accepted: 7 FEB 2012
- Manuscript Received: 18 AUG 2011
- Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH
Rheumatoid arthritis (RA) is associated with an increased cardiovascular (CV) burden similar to that of diabetes mellitus (DM). This risk may warrant preoperative CV assessment as is performed for patients with DM. We aimed to determine whether the risks of perioperative death and CV events among patients with RA differed from those among unaffected controls and patients with DM.
We used 1998–2002 data from the Nationwide Inpatient Sample (NIS) database of the Healthcare Cost Utilization Project (HCUP) to identify hospitalizations of patients undergoing elective noncardiac surgery. Using established guidelines, surgical procedures were categorized as either low risk, intermediate risk, or high risk of having CV events. Logistic models provided the adjusted odds of study end points in patients with RA, DM, or both relative to patients with neither condition.
Among 7,756,570 patients undergoing a low-risk, intermediate-risk, or high-risk noncardiac procedure, 2.34%, 0.51%, and 2.12%, respectively, had a composite CV event, and death occurred in 1.47%, 0.50%, and 2.59%, respectively. Among those undergoing an intermediate-risk procedure, death was less likely in RA patients than in DM patients (0.30% versus 0.65%; P < 0.001), but the difference in mortality rates among those undergoing low-risk versus high-risk procedures was not significant. Patients with RA were less likely to have a CV event than were patients with DM for procedures of low risk (3.38% versus 5.30%; P < 0.001) and intermediate risk (0.34% versus 1.07%; P < 0.001). In adjusted models, RA was not independently associated with an increased risk of perioperative death or a CV event.
RA was not associated with adverse perioperative CV risk or mortality risk, which suggests that current perioperative clinical care does not need to be changed in this regard.