Do rheumatoid arthritis patients have more major complications and length of stay after lower extremities fracture surgery?: A nationwide data with propensity score matching

Abstract

Patients with rheumatoid arthritis (RA) have a high risk of cardiovascular diseases and fractures. This retrospective cohort study explored whether patients with RA face higher complication risks or longer hospital stays than other patients when they had a lower limb fracture that required the surgery. Patients aged >45 years who received lower limb fracture surgeries between 2005 and 2012 were selected from the National Health Insurance Research Database, and 10 related variables including sex and age were used in propensity score matching to pair RA patients with non-RA patients in a 1:4 ratio. The final study sample comprised 1109 patients with RA and 4436 non-RA patients. The results indicated that 5.57% of the study sample had postoperative complications, accounting for 5.05% of patients with RA and 5.70% of the control group. After conditional logistic regression analysis was performed, the risk of major complications has no significant differences between patients with RA and the control group (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.61-1.24; P>.05). However, the comorbidity severity score exerted a significant effect on complications; patients with scores ≥3 were 2.78 times more likely to experience complications (OR=2.78; 95% CI 1.52-5.07). When considering different types of complications, patients with RA were less likely to be exposed to the risk of stroke (OR=0.48). After controlling all related factors, no significant differences were observed in the complication risks or deaths between the 2 groups (P>.05). Regarding hospitalization length, the average stay for all patients was 8.12 days; after controlling related factors, the hospitalization length for patients with RA was 0.97 times that of the control group, which was nonsignificant (P>.05). These results may provide some information to healthcare professionals when providing treatments. Abbreviations: CCI = Charlson Comorbidity Index, CI = confidence interval, CMU = China Medical University, DRGs = Diagnosis related groups, ICD-9-CM = International classification of diseases, 9th revision, clinical modification, ln = natural logarithm, NHIRD = National Health Insurance Research Database, OR = odds ratio, PSM = propensity score matching, RA = rheumatoid arthritis, REC = Research Ethic Committee, SD = standard deviation, SE = standard error.