Author information

1 Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.

2 Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.

3 Department of Orthopedic Surgery, Naval Hospital Camp Pendleton, Camp Pendleton, California.

4 Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota.

5 Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.

Abstract

BACKGROUND AND AIMS: There is a paucity of data on the safety of joint replacement surgery in patients with inflammatory boweldisease (IBD), including those on tumor necrosis factor-alpha inhibitors (anti-TNF). We explored the risk of serious infections in this population.

METHODS: A retrospective case-control study (2006-2014) was performed using the MarketScan® Database. All patients 18-64 years with an International Classification of Diseases code for IBD and an IBD-specific medication, with ≥6 months of enrollment prior to hip, knee or shoulder replacement surgery, were included. Ten non-IBD controls were frequency-matched to each case on length of enrollment, year, and the joint replaced. Primary outcome was serious infection (composite of joint infection, surgical site infection, pneumonia, sepsis) within 90 days of operation. Cox proportional hazards models were used to assess the association of IBD and IBD medications with serious infection.

RESULTS: More patients with IBD (N = 1455) had serious infections than controls (3.2% vs. 2.3%, P = 0.04), but not after controlling for comorbidities (hazard ratio [HR], 1.3; 95% confidence interval [CI], 0.95-1.76). Among IBD patients, corticosteroids were associated with increased risk of serious infection (HR 4.6; 95% CI, 2.2-9.8; P < .01) while anti-TNF was not. Opioids were also associated with increased risk of infection (HR 1.5; 95% CI, 1.2-1.8; P < .01).

CONCLUSIONS: After controlling for comorbidities, IBD patients were not at increased risk of serious infection following joint replacement. Corticosteroids, but not anti-TNFs or immunomodulators, were associated with increased risk of serious infections in IBD patients.