Pos0429 Does Stopping of Molecular Target Drugs Increase Postoperative Complications After Orthopaedic Surgeries in Patients With Rheumatoid Arthritis?

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Background: Most of rheumatoid arthritis (RA) practice guidelines and recommendations suggest stopping of molecular target drugs such as biological and targeted synthetic disease-modifying antirheumatic drugs before orthopaedic surgeries. However, there are still concerns on increasing complications after surgeries, and no convincing data are available yet [2]. Objectives: We aimed to investigate whether stopping of molecular target drugs before operations increase postoperative complications after orthopaedic surgeries in patients with RA in clinical practice by a multicenter cohort study. Methods: We collected cases of orthopaedic surgeries for patients with RA undergone from April, 2011 to March, 2017, in 19 specialized institutions in Japan. Demographic data, types of operations, drugs used for RA, stopping time periods of them, and postoperative complications within a year were recorded. We compared the incidence ratios of postoperative complications between stopping and no-stopping groups, among drug types, and among types of operations. Multivariate analyses were performed to investigate risk factors for delayed wound healing, surgical site infection (SSI), flare-up and death. Results: A total of 1953 cases were eligible for analyses. The averages of age, duration of the disease, and disease activity score 28 (DAS28)-CRP at the time of operation were 71.8 years, 18.6 years and 2.84, respectively. Methotrexate (MTX) and oral glucocorticoid were used in 59.5% and 58.0% of the patients. We set up two standards of stopping time period, and there were no statistical differences in incidence ratios of delayed wound healing, SSI and death in both standards, but the incidence ratio of flare-up was statistically higher in the stopping group. The incidence ratio of flare up was higher in IL-6 inhibitor group, and that of delayed wound healing was higher in major surgery group. Conclusion: The perioperative stopping of molecular target drugs may increase the incidence ratio of flare up in orthopaedic surgeries in patients with RA but does not influence those of other postoperative complications such as SSI. REFERENCES: [1] Ito H, et al. Non-Drug and Surgical Treatment Algorithm and Recommendations for the 2020 Update of the Japan College of Rheumatology Clinical Practice Guidelines for the Management of Rheumatoid Arthritis - Secondary Publication. Mod Rheumatol. 2023 Jan 3;33(1):36-45. [2] Ito H, et al. Does abatacept increase postoperative adverse events in rheumatoid arthritis compared with conventional synthetic disease-modifying drugs? J Rheumatol 2020;47;502-509. Acknowledgements: NIL. Disclosure of Interests: Hiromu Ito BMS, Hajime Ishikawa: None declared, Shigeyoshi Tsuji: None declared, Masanori Nakayama: None declared, Keiichiro Nishida: None declared, Takeshi Mochizuki: None declared, Kosuke Ebina: None declared, Toshihisa Kojima: None declared, Takumi Matsumoto: None declared, Ayako Kubota: None declared, Arata Nakajima: None declared, Atsushi Kaneko: None declared, Isao Matsushita: None declared, Ryota Hara: None declared, Koji Sakuraba: None declared, Yukio Akasaki: None declared, Tsukasa Matsubara: None declared, Yuichi Mochida: None declared, Katsuaki Kanbe: None declared, Natsuko Nakagawa: None declared, Koichi Murata: None declared, Masahide Hamaguchi: None declared, Shigeki Momohara: None declared.