title: National trends and in-hospital outcomes in patients with rheumatoid arthritis undergoing elective atlantoaxial spinal fusion surgery.
abstract: OBJECTIVE
  Atlantoaxial subluxation is a well-known cervical spinal disorder in rheumatoid arthritis (RA) and certain patients with this condition may need to receive atlantoaxial spinal fusion (AASF). However, there is limited information available regarding demographics and outcome trends. The purpose of this study is to present an analysis of RA patients who underwent elective AASF using national in-hospital data.
  
  
  METHODS
  Clinical data were derived from the US Nationwide Inpatient Sample (NIS) between 2000 and 2009. Patients who had a diagnosis of RA and underwent elective AASF, total hip arthroplasty (THA), and total knee arthroplasty (TKA) were identified. Data regarding patient- and healthcare system-related characteristics, comorbidities, in-hospital complications, and mortality were retrieved. The trends of the procedures were analysed.
  
  
  RESULTS
  There were 1,460 RA patients aged ≥18 who underwent elective AASF between 2000 and 2009. During the last decade, the incidence of elective AASF in RA patients remained stable. The overall in-hospital complication rate of AASF in RA patients was 10.9%, which was more than twice that of THA and TKA in RA patients (THA: 4.8%; TKA: 4.9%). Respiratory complication rate (5.3%) was the highest among the complications. In-hospital mortality rate of such patients was 1.1%.
  
  
  CONCLUSIONS
  During the last decade, the incidence of elective AASF in RA patients remained stable. In-hospital morbidity and mortality rates of AASF in RA patients were higher than those of other major orthopaedic surgeries in RA patients. Respiratory management is particularly important after AASF in RA patients.
authors.affiliation: Department of Orthopaedic Surgery & Rehabilitation Medicine SUNY Downstate Medical Center, NY, USA; and Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. hiroyoshihara55@yahoo.co.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshihara
authors.affiliation: Department of Statistical Sciences, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoneoka
authors.affiliation: Department of Orthopaedic Surgery & Rehabilitation Medicine SUNY Downstate Medical Center, NY, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Margalit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001268:Atlanto-Axial Joint / Q000293:injuries / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods / Q000639:trends*; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000379:methods / Q000639:trends*; D016896:Treatment Outcome; D055815:Young Adult