title: Adverse outcomes after major surgery in patients with systemic lupus erythematosus: a nationwide population-based study.
abstract: OBJECTIVE
  To investigate the postoperative adverse outcomes among surgical patients with preoperative systemic lupus erythematosus (SLE) in a nationwide population-based study.
  
  
  METHODS
  We used Taiwan's National Health Insurance Research Database to identify 4321 surgical inpatients with SLE and 17 284 sex- and age-matched controls receiving major surgery. Sociodemographic characteristics, preoperative comorbidities, postoperative 30-day in-hospital major complications and mortality were analysed among surgical patients with and without SLE.
  
  
  RESULTS
  Surgical patients with SLE had a higher prevalence of preoperative coexisting medical conditions and postoperative major complications. The OR of 30-day postoperative mortality for surgical patients with SLE was 1.71 (95% CI 1.09 to 2.67) after adjustment. Surgical patients who had received more recent (within 6 months) preoperative SLE-related inpatient care had higher risks of 30-day postoperative acute renal failure (OR=7.23, 95% CI 4.52 to 11.6), pneumonia (OR=2.60, 95% CI 1.82 to 3.72), pulmonary embolism (OR=4.86, 95% CI 1.20 to 19.7), septicaemia (OR=3.43, 95% CI 2.48 to 4.74), stroke (OR=2.01, 95% CI 1.38 to 2.92), overall complications (OR=2.30, 95% CI 1.89 to 2.80) and 30-day postoperative mortality (OR=2.39, 95% CI 1.28 to 4.45) than surgical patients without SLE. SLE-related preoperative steroid injections showed a dose-dependent relationship with postoperative complications and mortality.
  
  
  CONCLUSIONS
  SLE significantly increased the risks of surgical patients for overall major complications and mortality after major surgery. Our findings demonstrated the need for integrated care and revised protocols for perioperative management to improve outcomes for surgical patients with SLE.
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jui-An
authors.initials: JA
authors.lastname: Lin
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Liao
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yi-Jui
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chih-Hsiung
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, Sun Yet-Sen University, Guangdong, People's Republic of China.
authors.forename: Wen-Qi
authors.initials: WQ
authors.lastname: Huang
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ta-Liang
authors.initials: TL
authors.lastname: Chen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D017678:Sex Distribution; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D005938:Glucocorticoids
keywords: Health services research; Outcomes research; Systemic Lupus Erythematosus