title: The Association Between Rheumatoid Arthritis and Adverse Postoperative Outcomes: A Retrospective Analysis.
abstract: Patients with rheumatoid arthritis have a high overall incidence of mortality, primarily because of cardiovascular complications. Thus, we tested the primary hypothesis that rheumatoid arthritis is independently associated with increased postoperative cardiovascular complications. Second, we determined whether rheumatoid arthritis is associated with increased thromboembolic complications, microcirculatory complications, and mortality.
  
  
  
  We obtained censuses of 2009 to 2010 inpatient hospital discharge data across 7 states (Arizona, California, Florida, Iowa, Maryland, Michigan, and New Jersey). Rheumatoid arthritis was identified using the present-on-admission diagnosis code 714.0. Each rheumatoid arthritis discharge that had surgery was propensity matched to a control discharge. Multivariable logistic regression was used to compare matched rheumatoid arthritis and control patients on risk of in-hospital cardiovascular complications.
  
  
  
  Among 5.5 million qualifying discharges, the matching procedure yielded successful 66,886 matched pairs. One thousand ninety-five (1.64%) of the matched rheumatoid arthritis discharges and 1006 (1.50%) of the matched controls had in-hospital cardiovascular complications. The adjusted odds ratio (99% confidence interval) was estimated at 1.08 (0.96-1.21; P = 0.08). There were no significant differences in the odds of in-hospital thromboembolic complications (1.03 [0.93-1.15]; P = 0.42), in-hospital microcirculatory complications (0.94 [0.86-1.01]; P = 0.03), or in-hospital mortality (1.11 [0.98-1.25]; P = 0.04).
  
  
  
  Rheumatoid arthritis was not associated with an increased risk for postoperative cardiovascular complications.
authors.affiliation: From the Departments of *Outcomes Research and †Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; ‡Department of Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio; and §Department of Anesthesiology, Northwestern University, Evanston, Illinois.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Sun
authors.forename: Brian D
authors.initials: BD
authors.lastname: Hesler
authors.forename: Natalya
authors.initials: N
authors.lastname: Makarova
authors.forename: Jarrod E
authors.initials: JE
authors.lastname: Dalton
authors.forename: Michael
authors.initials: M
authors.lastname: Doan
authors.forename: Amanda
authors.initials: A
authors.lastname: Moraska
authors.forename: Gildasio
authors.initials: G
authors.lastname: De Oliveira
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States