title: Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty.
abstract: The optimal timing of tumor necrosis factor antagonists before elective surgery is unknown. This study evaluated the association between infliximab timing and serious infection after elective hip or knee arthroplasty.
  
  
  
  A retrospective cohort study evaluated US Medicare patients with rheumatoid arthritis, inflammatory bowel disease, psoriasis, psoriatic arthritis, or ankylosing spondylitis who received infliximab within 6 months of elective knee or hip arthroplasty from 2007 to 2013. Propensity-adjusted analyses examined whether infliximab stop timing (time between the most recent infusion and surgery) was associated with hospitalized infection within 30 days or prosthetic joint infection (PJI) within 1 year.
  
  
  
  Hospitalized infection within 30 days occurred after 270 of 4,288 surgeries (6.3%). Infliximab stop timing <4 weeks versus 8-12 weeks was not associated with an increase in infection within 30 days (propensity-adjusted odds ratio [OR] 0.90 [95% confidence interval (95% CI) 0.60-1.34]). The rate of PJI was 2.9 per 100 person-years and was not increased in patients with stop timing <4 weeks versus 8-12 weeks (hazard ratio [HR] 0.98 [95% CI 0.52-1.87]). Glucocorticoid dosage >10 mg/day was associated with increased risk of 30-day infection (OR 2.11 [95% CI 1.30-3.40]) and PJI (HR 2.70 [95% CI 1.30-5.60]). Other risk factors for infection included elderly age, comorbidities, revision surgery, and previous hospitalized infection.
  
  
  
  Administering infliximab within 4 weeks of elective knee or hip arthroplasty was not associated with a higher risk of short- or long-term serious infection compared to withholding infliximab for longer time periods. Glucocorticoid use, especially >10 mg/day, was associated with an increased infection risk.
authors.affiliation: University of Pennsylvania, Philadelphia.
authors.forename: Michael D
authors.initials: MD
authors.lastname: George
authors.affiliation: University of Pennsylvania and Philadelphia Veterans Affairs Medical Center, Philadelphia.
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Baker
authors.affiliation: University of Pennsylvania, Philadelphia.
authors.forename: Jesse Yenchih
authors.initials: JY
authors.lastname: Hsu
authors.affiliation: University of Pennsylvania, Philadelphia.
authors.forename: Qufei
authors.initials: Q
authors.lastname: Wu
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Fenglong
authors.initials: F
authors.lastname: Xie
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Lang
authors.initials: L
authors.lastname: Chen
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Huifeng
authors.initials: H
authors.lastname: Yun
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D007720:Knee Prosthesis / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D016017:Odds Ratio; D057216:Propensity Score; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D000069285:Infliximab