Abstract：
OBJECTIVE: The safety and analgesic efficacy of perioperative glucocorticoids have been established for patients without rheumatoid arthritis. Therefore, our study aims to investigate whether similar benefits can be observed in patients with rheumatoid arthritis undergoing total joint arthroplasty. Specifically, we aim to explore the impact of perioperative glucocorticoid use on postoperative complications, opioid consumption, incidence of hypotension, hyperglycemia, 30-day mortality, and 90-day re-admission in this patient population.
METHODS: Approval for the study protocol was obtained from the Medical Research Ethics Committee at Sichuan University, aligning with the principles outlined in the Declaration of Helsinki. We retrospectively analyzed a consecutive series of patients with rheumatoid arthritis who underwent total joint arthroplasty at our medical center between November 2009 and April 2021 and who were not on chronic glucocorticoid therapy before surgery. Those who received glucocorticoids at any time during hospitalization were compared to those who did not in terms of acute complications within 90 days after surgery as well as postoperative rescue opioid consumption, hypotension, and hyperglycemia during hospitalization. The two groups were also compared in terms of overall duration of hospitalization, all-cause mortality within 30 days, and readmission for any reason within 90 days. Continuous data were assessed for significance using the independent-samples t test. Categorical data were assessed using the Pearson chi-squared test.
RESULTS: Of the 849 patients included in the analysis, 598 administered perioperative glucocorticoids and 251 did not. Prior to surgery, the two groups did not differ significantly in any clinicodemographic variable that we examined. The incidence of acute postoperative complications (2.3% vs. 4.0%, p = 0.187) and acute postoperative infection (2.0% vs. 2.8%, p = 0.482) was comparable between those who received perioperative glucocorticoids and those who did not, but the former group exhibited a significantly lower incidence of rescue opioid use (17.9% vs. 44.6%, p < 0.001) as well as significantly lower total rescue opioid consumption (4.7 ± 2.1 mg vs. 8.9 ± 4.6 mg, p < 0.001). However, the two groups showed similar incidences of postoperative hypotension, hyperglycemia, 30-day mortality, and 90-day re-admission.
CONCLUSIONS: Perioperative glucocorticoids may reduce the need for rescue opioids after total joint arthroplasty of rheumatoid arthritis patients, without increasing the incidence of acute complications, hypotension or hyperglycemia.
METHODS: Approval for the study protocol was obtained from the Medical Research Ethics Committee at Sichuan University, aligning with the principles outlined in the Declaration of Helsinki. We retrospectively analyzed a consecutive series of patients with rheumatoid arthritis who underwent total joint arthroplasty at our medical center between November 2009 and April 2021 and who were not on chronic glucocorticoid therapy before surgery. Those who received glucocorticoids at any time during hospitalization were compared to those who did not in terms of acute complications within 90 days after surgery as well as postoperative rescue opioid consumption, hypotension, and hyperglycemia during hospitalization. The two groups were also compared in terms of overall duration of hospitalization, all-cause mortality within 30 days, and readmission for any reason within 90 days. Continuous data were assessed for significance using the independent-samples t test. Categorical data were assessed using the Pearson chi-squared test.
RESULTS: Of the 849 patients included in the analysis, 598 administered perioperative glucocorticoids and 251 did not. Prior to surgery, the two groups did not differ significantly in any clinicodemographic variable that we examined. The incidence of acute postoperative complications (2.3% vs. 4.0%, p = 0.187) and acute postoperative infection (2.0% vs. 2.8%, p = 0.482) was comparable between those who received perioperative glucocorticoids and those who did not, but the former group exhibited a significantly lower incidence of rescue opioid use (17.9% vs. 44.6%, p < 0.001) as well as significantly lower total rescue opioid consumption (4.7 ± 2.1 mg vs. 8.9 ± 4.6 mg, p < 0.001). However, the two groups showed similar incidences of postoperative hypotension, hyperglycemia, 30-day mortality, and 90-day re-admission.
CONCLUSIONS: Perioperative glucocorticoids may reduce the need for rescue opioids after total joint arthroplasty of rheumatoid arthritis patients, without increasing the incidence of acute complications, hypotension or hyperglycemia.
摘要：
目的：已经确定了围手术期糖皮质激素对无类风湿性关节炎患者的安全性和镇痛效果。因此,我们的研究目的是调查在接受全关节置换术的类风湿性关节炎患者中是否可以观察到类似的益处.具体来说,探讨围手术期使用糖皮质激素对术后并发症的影响,阿片类药物的消费，低血压的发生率，高血糖症,30天死亡率，以及该患者人群的90天再次入院。
方法：研究方案获得四川大学医学研究伦理委员会的批准，符合赫尔辛基宣言中概述的原则。我们回顾性分析了2009年11月至2021年4月在我们的医疗中心接受全关节置换术的连续一系列类风湿关节炎患者，这些患者在手术前没有接受慢性糖皮质激素治疗。将住院期间任何时间接受糖皮质激素的患者与术后90天内未发生急性并发症的患者进行比较，低血压,住院期间高血糖。同时比较两组总住院时间,30天内全因死亡率,并在90天内以任何理由重新接纳。使用独立样本t检验评估连续数据的显著性。分类数据使用皮尔逊卡方检验进行评估。
结果：在纳入分析的849例患者中，598例给予围手术期糖皮质激素，251例未给予。手术前,两组在我们检查的任何临床人口统计学变量方面均无显著差异.术后急性并发症发生率（2.3%vs.4.0%，p=0.187）和急性术后感染（2.0%vs.2.8%，p=0.482）在接受围手术期糖皮质激素的患者和未接受糖皮质激素的患者之间具有可比性，但前一组显示救援阿片类药物使用的发生率显着降低(17.9%vs.44.6%,p<0.001）以及显着降低的总救援阿片类药物消费量（4.7±2.1mgvs.8.9±4.6mg,p<0.001)。然而,两组患者术后低血压发生率相似,高血糖症,30天死亡率，90天的重新入学。
结论：围手术期糖皮质激素可减少类风湿关节炎患者全关节置换术后对阿片类药物的需要，在不增加急性并发症发生率的情况下，低血压或高血糖。
方法：研究方案获得四川大学医学研究伦理委员会的批准，符合赫尔辛基宣言中概述的原则。我们回顾性分析了2009年11月至2021年4月在我们的医疗中心接受全关节置换术的连续一系列类风湿关节炎患者，这些患者在手术前没有接受慢性糖皮质激素治疗。将住院期间任何时间接受糖皮质激素的患者与术后90天内未发生急性并发症的患者进行比较，低血压,住院期间高血糖。同时比较两组总住院时间,30天内全因死亡率,并在90天内以任何理由重新接纳。使用独立样本t检验评估连续数据的显著性。分类数据使用皮尔逊卡方检验进行评估。
结果：在纳入分析的849例患者中，598例给予围手术期糖皮质激素，251例未给予。手术前,两组在我们检查的任何临床人口统计学变量方面均无显著差异.术后急性并发症发生率（2.3%vs.4.0%，p=0.187）和急性术后感染（2.0%vs.2.8%，p=0.482）在接受围手术期糖皮质激素的患者和未接受糖皮质激素的患者之间具有可比性，但前一组显示救援阿片类药物使用的发生率显着降低(17.9%vs.44.6%,p<0.001）以及显着降低的总救援阿片类药物消费量（4.7±2.1mgvs.8.9±4.6mg,p<0.001)。然而,两组患者术后低血压发生率相似,高血糖症,30天死亡率，90天的重新入学。
结论：围手术期糖皮质激素可减少类风湿关节炎患者全关节置换术后对阿片类药物的需要，在不增加急性并发症发生率的情况下，低血压或高血糖。
