title: Perioperative all-cause mortality and cardiovascular events in patients with rheumatoid arthritis: comparison with unaffected controls and persons with diabetes mellitus.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Hospital Medicine, Department of Medicine, Reading Hospital and Medical Center, Sixth Avenue and Spruce Street, West Reading, PA 19612, USA. a.yazzzd@gmail.com
authors.forename: Ali
authors.initials: A
authors.lastname: Yazdanyar
authors.forename: Mary Chester
authors.initials: MC
authors.lastname: Wasko
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kraemer
authors.forename: Michael M
authors.initials: MM
authors.lastname: Ward
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002423:Cause of Death; D015897:Comorbidity; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors