Effect of Rheumatoid Arthritis on Postoperative Outcomes in Patients with Lumbar Spinal Disorders: A Systematic Review and Meta-Analysis

Abstract

Study Design: A systematic review and meta-analysis. Objective: This study aimed to determine whether rheumatoid arthritis (RA) is associated with clinical outcomes following spinal surgery for lumbar spinal disorders. Methods: MEDLINE, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform were comprehensively searched for observational studies comparing clinical outcomes after lumbar spine surgery in patients with and without RA (>18 years). Quality assessment was conducted using the Quality in Prognosis Studies assessment tool. Pooled odds ratios (ORs) and hazard ratios were calculated for reoperation and surgical site infection by using a random effects model. Subgroup analyses were conducted to examine the effect of surgery type. Results: Seven studies with 72, 969 patients, including 7518 patients with RA, were analyzed. All studies had a moderate risk of bias. Patients with RA had a significantly higher odds of reoperation (OR: 5.57; 95% confidence interval [CI]: 1.10-28.26; I2 = 92%; P = 0.04) and higher odds of surgical site infection (OR: 1.47; 95% CI: 1.28-1.69; I2 = 2%; P < 0.01). No statistically significant difference was found in reoperation-free survival between patients with RA and those without RA (hazard ratio: 1.15; 95% CI: 0.94-1.40; I2 = 100%; P = 0.16). Patients with RA had higher complication rates, with incidence rates ranging from 13.5% to 57%, compared with those without RA. Conclusion: Compared with patients without RA, patients with RA may be more likely to undergo reoperations and suffer from complications following surgery for lumbar spine lesions.