Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Hospital-Based Surgical Procedures and the Risk of Perioperative Cardiovascular Events: A Comparison Study of Rheumatoid Arthritis and Diabetes Mellitus Using the National Inpatient Sample of the Healthcare Cost and Utilization Project.

Yazdanyar2,  Ali, Wasko3,  Mary C., Kraemer3,  Kevin L., Ward1,  Michael M.

National Institute of Arthritis and Musculoskeletal and Skin Diseases
St Luke's Hospital, Bethlehem, PA
University of Pittsburgh

Background:

The association of rheumatoid arthritis with increased atherosclerotic burden has led some to equate the cardiovascular risk of rheumatoid arthritis (RA) with that of diabetes mellitus (DM). We compared the risk of perioperative cardiovascular outcomes among patients with RA, DM, both conditions, and neither.

Methods:

This is a cross-sectional analysis of the National Inpatient Sample of the HealthCare Utilization Projects using data from years 1998 to 2002. We abstracted the diagnoses of RA, DM, potential confounding comorbidities and the principal surgical procedure using International Classification of Diseases, ninth revision codes. The principal surgical procedure was categorized into Low, Intermediate, and High risk according to established guidelines. The study endpoint was a composite cardiovascular outcome including an acute myocardial infarction, acute stroke, non-ST elevation MI, and/or congestive heart failure with pulmonary edema. Logistic regression accounting for survey design provided the adjusted magnitude of association between the covariates and the study endpoint.

Results:

The total weighted frequency of hospitalizations with Low, Intermediate, and High risk principal procedures was 1 003 904, 6 011 950, and 277 010, respectively. The weighted frequency for individuals with RA without DM was 7 831, 92 005, and 1 767 for Low, Intermediate, and High risk surgical procedures, respectively. The weighted frequency of composite cardiovascular events in Low, Intermediate, and High surgical risk levels were 9 542, 38 542, and 31 772, respectively. The proportion of composite cardiovascular events was higher in DM as compared to RA patients for Low (1.63% vs. 0.81%), Intermediate (1.03% vs. 0.44%), and High (18.53% vs. 6.61%) risk surgical procedures. Relative to individuals without RA or DM, the adjusted odds of composite cardiovascular event in patients with RA without DM was 0.73 (95% confidence interval [CI]: 0.41, 1.30), 0.68 (95% CI: 0.54, 0.85), and 0.76 (95% CI: 0.47,1.22) for Low, Intermediate, and High risk surgical procedures, respectively. Relative to individuals without RA or DM, diabetics without RA undergoing a Low, Intermediate, and High risk surgical procedures had an adjusted odds of composite cardiovascular endpoint of 1.30 (95% CI: 1.16,1.45), 1.23(95% CI: 1.15,1.32), and 1.67(95% CI: 1.53,1.83), respectively.

Table. Odds of In-hospital Composite Cardiovascular Event by Risk Category of Principal Procedure

  Surgical Risk Category 
 Low OR (95% CI)Intermediate OR (95% CI)High OR (95% CI)
Characteristics
Non-RA, Non-DM1.001.001.00
RA, Non-DM0.73 (0.41,1.30)0.68 (0.54,0.85)0.76 (0.47,1.22)
Non-RA, DM1.30 (1.16,1.45)1.23 (1.15,1.32)1.67 (1.53,1.83)
RA, DM1.48 (0.59,3.70)0.91 (0.50,1.64)0.84 (0.34,2.05)
Age, y
18–501.001.001.00
50–752.61 (2.11,3.24)12.53 (10.23,15.36)3.10 (2.69,3.57)
>754.41 (3.45,5.63)33.46 (27.54,40.66)4.34 (3.74,5.03)
Gender
Female0.74 (0.66,0.82)0.88 (0.84,0.92)0.65 (0.61,0.70)
Comorbidities
HTN1.08 (0.97,1.19)0.65 (0.61,0.69)0.55 (0.50,0.61)
CHF2.49 (2.20,2.83)5.49 (5.16,5.85)2.17 (2.00,2.35)
VHD2.79 (2.16,3.59)2.55 (2.22,2.94)0.47 (0.41,0.54)
CKD1.66 (1.21,2.28)1.67 (1.36,2.06)0.69 (0.53,0.89)
Admission Type
Elective0.24 (0.20,0.30)0.45 (0.42,0.48)0.15 (0.14,0.17)
Abbreviations: n, represents number; OR, Adjusted Odds Ratio; CI, Confidence internal; y, years; %, percent; SE, Lineared Standard Error; RA, rheumatoid arthritis; DM, diabetes mellitus; HTN, hypertension; CHF, congestive heart failure; VHD, valvular heart disease; CKD, chronic kidney disease. * Model adjusting for confounding covariates of age, gender, type of admission, and comorbidities including hypertension, congestive heart failure, valvular heart diseases, and chronic kidney disease.

Conclusions:

Rheumatoid arthritis was not an independent predictor of perioperative cardiovascular events. In contrast, diabetes mellitus was associated with increased odds of cardiovascular outcomes across all surgical risk levels.

To cite this abstract, please use the following information:
Yazdanyar, Ali, Wasko, Mary C., Kraemer, Kevin L., Ward, Michael M.; Hospital-Based Surgical Procedures and the Risk of Perioperative Cardiovascular Events: A Comparison Study of Rheumatoid Arthritis and Diabetes Mellitus Using the National Inpatient Sample of the Healthcare Cost and Utilization Project. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1039
DOI: 10.1002/art.28806

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