Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery

Abstract

Background

We aimed to identify risk factors for early complications in systemic lupus erythematosus (SLE) patients undergoing major surgery.

Methods

We conducted a retrospective comparative cohort study including patients with SLE undergoing major surgery, and non-SLE patients matched 1:1. Main outcomes were development of infectious and noninfectious complications, and 30-day postoperative mortality.

Results

A total of 382 patients (191 SLE and 191 non-SLE) were included. Postoperative complications occurred in 82 (43%) SLE patients and 58 (30%) without SLE, (p = 0.01). Variables associated with infectious complications in SLE patients: prednisone use (OR 1.81, 95% CI 1.13–2.90), anemia (OR 2.43, 95% CI 1.45–4.08), hypoalbuminemia (OR 2.58, 95% CI 1.55–4.30) and lymphopenia (OR 2.43, 95% CI 1.52–3.89), p < 0.05. Variables associated with noninfectious complications: anemia (OR, 1.93, 95% CI 1.03–3.64) and hypoalbuminemia (OR 2.11, 95% CI 1.16–3.86), p < 0.05. Variables associated with any complication: SLEDAI-2K (OR 1.1, 95% CI 1.01–1.20), nephritis (OR 10.08, 95% CI 1.21–83.63), aspirin use (OR 2.68, 95% CI 1.19–6.02, p = 0.01), low C3 (OR 2.00, 95% CI 1.06–3.80), anemia (OR 2.68, 95% CI 1.39–5.18), hypoalbuminemia (OR 3.49, 95% CI 1.83–6.66) and lymphopenia (OR 2.36, 95% CI 1.30–4.26), p < 0.05. More patients with SLE died (6% vs 1%, p = 0.02).

Conclusions

SLE patients present higher frequency of postoperative complications and mortality compared with non-SLE patients. Hypoalbuminemia, anemia, lymphopenia and aspirin use are independent risk factors.