e43 The management of biologics peri-operatively and post-operatively

Abstract

Background: Evidence around the management of biologics periand post-operatively is sparse, decisions are made on expert opinion rather than evidence based. The recently published ACR guidelines aid decision making around orthopaedics related surgery, with a lack of research on general surgery. BSR Guidelines safety in biologics 2010 also give advice with new guidelines in development. We have a large database of patients on biologics. The aim of this audit is to look at what is the current practice in our department. Methods: We sampled first 98 patients from the biologics database, eldest patients first. The rationale is that older patients are more likely to require surgery. Using electronic patient record systems, we looked to see if patients had surgery whilst on biologics. We then looked for clinic letters/documentation that would give an indication to when the biologics were stopped and re-started. If information was unclear, we called the patient. Data was collected and tabulated using Microsoft Excel. Results: Out of 98 patients, 33 patients (34%) had surgery. 82% of patient sampled had rheumatoid arthritis, 10% had psoriatic arthritis, 5% had ankylosing spondylitis, and 1% had enteropathic arthritis. Biologics used include: 28% on adalimumab, 26% on rituximab, 14% on entaercept (benepali), and 12% on inflectra (Table 1). The rest included abatacept, golimumab, tocilizumab, infliximab and ustekinumab. The table illustrates when the biologics were stopped or restarted. Six (18%) patients had post-surgical complication. 2 of the patients had UTI, 2 patients had pneumonia, 1 patient had wound dehiscence, and one had urosepsis and cellulitis. Conclusion: Looking at data gathered, the current practice is wideranging. The majority of the biologics were stopped peri-operatively. A small percentage fall into the emergency category so it was more difficult to predict. Most of the patients fall into the categories of having their biologics stopped one to two weeks before the surgery, which was departmental procedure at the time. However, there is a significant proportion that are not managed within these parameters. There is a clear need for education for our non-specialist colleagues. A succinct, easy to follow guideline would be helpful and would allow a uniform management for all patients. (Table Presented).