title: Postoperative complications in patients with rheumatoid arthritis using a biological agent - A systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate, through a systematic review of the literature, the association between the use of biological disease-modifying antirheumatic drugs (bDMARDs) and surgical site infection (SSI) or wound healing delay after orthopedic surgery in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  A systematic review of articles indexed in the Cochrane Library, PubMed, and Web of Science from 1992 to 2012 was performed. The search aimed to identify studies describing SSI or wound healing delay in patients with RA treated with or without bDMARDs. Articles fulfilling the predefined inclusion criteria were reviewed systematically and their quality was appraised.
  
  
  RESULTS
  There was no Cochrane review on this subject. We found 75 articles through specific searches of PubMed and Web of Science, and hand searching. After inclusion and exclusion by full-text review, 10 articles were found for SSI, and 5 articles for delayed wound healing. The use of bDMARDs appeared to increase the rate of SSI slightly, especially in large joint-replacement surgery. Delayed wound healing was not increased by the use of bDMARDs. However, the definitions of SSI and delayed wound healing varied between the reviewed articles. Most of the articles focused on tumor necrosis factor-α inhibitors.
  
  
  CONCLUSIONS
  bDMARDs slightly increase the relative risk of SSI but not that of delayed wound healing after orthopedic surgery and should be used with appropriate caution.
authors: a Department of Orthopaedic Surgery , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors: Hiromu
authors: H
authors: Ito
authors: Masayo
authors: M
authors: Kojima
authors: Keiichiro
authors: K
authors: Nishida
authors: Isao
authors: I
authors: Matsushita
authors: Toshihisa
authors: T
authors: Kojima
authors: Takeo
authors: T
authors: Nakayama
authors: Hirahito
authors: H
authors: Endo
authors: Shintaro
authors: S
authors: Hirata
authors: Yuko
authors: Y
authors: Kaneko
authors: Yutaka
authors: Y
authors: Kawahito
authors: Mitsumasa
authors: M
authors: Kishimoto
authors: Yohei
authors: Y
authors: Seto
authors: Naoyuki
authors: N
authors: Kamatani
authors: Kiichiro
authors: K
authors: Tsutani
authors: Ataru
authors: A
authors: Igarashi
authors: Mieko
authors: M
authors: Hasegawa
authors: Nobuyuki
authors: N
authors: Miyasaka
authors: Hisashi
authors: H
authors: Yamanaka
mesh_terms: D018501:Antirheumatic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D018501:Antirheumatic Agents
keywords: Biological agent; Delayed wound healing; Perioperative complication; Rheumatoid arthritis; Surgical site infection; Systematic review