Chronic Immunosuppressive Medication and Postoperative Infectious Outcomes In Primary Total Joint Arthroplasty Patients

Author(s):
Jasmine Patel; Ghulam Saadat; Maria Shahzad; Laura Brown; Faran Bokhari

Background:

To assess the effect of chronic immunosuppressive medication on 30-day postoperative quality outcomes, including infectious complications, major non-infectious complications, readmissions, and hospital length of stay in primary TJA patients.

Hypothesis:

Chronic immunosuppressive medication increases the risk of 30-day postoperative quality outcomes, including infectious complications, major non-infectious complications, readmissions, and hospital length of stay in primary TJA patients.

Methods:

We conducted a retrospective cohort study of 501,582 primary TJA patients from the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) between 2016 and 2020. Patients were dichotomized by immunosuppressant use. Logistic and linear regression models were used to assess the association between immunosuppressant use and postoperative outcomes. Regression models were adjusted for age, sex, body mass index, smoking status, 5-item modified frailty index, and American Society of Anesthesiologists classification status.

Results:

Immunosuppressive medication use was observed in 3.6% of the patients. Compared to non-users, those who used immunosuppressants experienced higher rates of infectious complications (3.6% vs. 2.1%, p < 0.001). This was also true for major non-infectious complications (4% vs. 2.6%, p < 0.001), and readmissions (6.4% vs. 3.8%, p < 0.001). The mean hospital length of stay for immunosuppressant users was 2.32 ± 3.67 days compared to non-users (2 ± 3.09 days); p < 0.001. After adjusting for confounders, immunosuppressive medication use was associated with a 54% increase in the odds of infectious complications (95% CI: 1.41-1.67, p < 0.001). In addition a 45% increase in the odds of major non-infectious complications (95% CI: 1.34-1.57, p < 0.001), and a 59% increase in the odds of readmissions (95% CI: 1.48-1.7, p < 0.001) was observed. In terms of hospital length of stay, patients who used immunosuppressants had an increase of 0.22 days (SE = 0.02, p < 0.001) compared to non-users.

Conclusions:

This study demonstrates that chronic immunosuppressive medication use is associated with increased short-term postoperative adverse events in primary TJA patients.This is particularly true for infectious complications. Careful perioperative management and risk stratification should be considered for these patients to optimize surgical outcomes.