The risk of post-operative complications in psoriasis and psoriatic arthritis patients on biologic therapy undergoing surgical procedures
The risk of post-operative complications in psoriasis and psoriatic arthritis patients on biologic therapy undergoing surgical procedures
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DOI：
10.1111/jdv.12997
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发表时间：
2016-01-01
影响因子：
9.2
通讯作者：
Warren, R. B.
中科院分区：
文献类型：
--
作者：
Bakkour, W.;Purssell, H.;Warren, R. B.
背景：对于正在接受外科手术的银屑病和/或银屑病关节炎（PsA）患者是否应该停止或继续生物治疗，证据有限。目前的护理指南建议，在那些接受重大外科手术的患者中，有计划地中断生物治疗。目的根据护理指南，对三级转诊银屑病门诊围手术期生物治疗的现行管理实践进行审计，并调查持续/方法回顾性分析银屑病和PsA患者，生物疗法一个形式被用来收集信息的生物制品使用，他们是否被停止围手术期和患者是否开发术后并发症和/或疾病flake.Results共42例患者有77个程序被确定。手术范围从皮肤手术到整形外科和心胸外科手术。大多数手术（76%）继续进行生物治疗。继续使用生物制剂治疗的患者和停止使用生物制剂治疗的患者（包括接受大手术的患者）术后感染和伤口愈合延迟的风险无显著差异。围手术期中断生物治疗与银屑病或PsA.Conclusion复发风险显著相关（P = 0.003），持续生物治疗银屑病和PsA患者围手术期并不增加术后并发症的风险。围手术期中断生物治疗显著增加了疾病发作的风险。本研究受队列规模限制，需要重复研究，理想情况下采用前瞻性随机对照方式。
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.Conclusion 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.