The risk of post-operative complications in psoriasis and psoriatic arthritis patients on biologic therapy undergoing surgical procedures.
BACKGROUND
There is limited evidence as to whether biologic therapy should be stopped or continued in patients with psoriasis and/or psoriatic arthritis (PsA) who are undergoing surgical procedures. Current guidelines of care recommend a planned break from biologic therapy in those undergoing major surgical procedures.


OBJECTIVE
To audit current practice of managing biologic therapy peri-operatively in a tertiary referral psoriasis clinic against guidelines of care and to investigate the effects of continuing/stopping biologic therapy in psoriasis and PsA patients.


METHODS
A retrospective audit of psoriasis and PsA patients who had a surgical procedure whilst on biologic therapy. A proforma was used to collect information on the biologics used, whether they were stopped peri-operatively and whether patients developed post-operative complications and/or disease flare.


RESULTS
A total of 42 patients who had 77 procedures were identified. Procedures ranged from skin surgery to orthopaedic and cardiothoracic surgery. Biologic therapy was continued in the majority of procedures (76%). There was no significant difference in post-operative risk of infection and delayed wound healing between those patients who continued and those who stopped biologic therapy, including those undergoing major surgery. Interrupting biologic therapy peri-operatively was associated with a significant (P = 0.003) risk of flare of psoriasis or PsA.


CONCLUSIONS
Continuing biologic therapy in psoriasis and PsA patients peri-operatively did not increase the risk of post-operative complications. Interrupting biologic therapy peri-operatively significantly increased the risk of disease flare. This study is limited by cohort size and requires replication, ideally in a prospective randomized controlled manner.
The Dermatology Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, University of Manchester, UK.
W
W
Bakkour
The Dermatology Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, University of Manchester, UK.
H
H
Purssell
Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
H
H
Chinoy
The Dermatology Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, University of Manchester, UK.
C E M
CE
Griffiths
The Dermatology Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, University of Manchester, UK.
R B
RB
Warren
D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D001685:Biological Factors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011565:Psoriasis / Q000188:drug therapy*; D012189:Retrospective Studies; D012306:Risk; D013514:Surgical Procedures, Operative
D001685:Biological Factors