Awareness of perioperative medication management of rheumatologic patients undergoing elective surgery amongst surgeons and anaesthetists
Fahy E, Whelan B
Rheumatology Department, Our Lady’s Hospital Manorhamilton; Sligo University Hospital
Rheumatologic patients may be on a number of medications which act as immunological suppressants. This can be of concern in those patients undergoing surgery due to risk of local or systemic infection postoperatively. Guidelines and principles exist recommending the best time to stop medications pre-op and restart post-op if indicated.
We sought to assess awareness of recommendations amongst surgeons and anaesthetists.
Questionnaire on awareness of guidelines for DMARDs, Biologics, SLE-specific medications(in non-severe SLE) for elective procedures only. All grades included(SHO/Registrar/Consultant); general surgery, orthopaedics, ENT, urology, anaesthetics. For each medication group, we asked where the subject seeks guidance and if they would stop preop and when+restart postop and when(assuming uncomplicated postop course). Answers based on ACR recommendations.
22 subjects were surveyed: 4 consultants, 11 registrars and 7 senior house officers. For DMARDs, a majority of participants(33.33%) said they would seek rheumatology advice. 9/22(40.90%) stated correctly that they would not hold DMARDs preop. Of all participants, only 8.33% were correct across the biologic agents category for when to stop preop. The majority answer(41.66%) was that the participant did not know when to stop the biologic agents preop. The majority answer for restart time 10/22(45.45%) was correct in that the biologic agents would be restarted 2 weeks postop. For SLE specific medications, 46.66% stated they would seek rheumatology advice. 12/22(54.54%) selected correctly that they would stop SLE medications preop but only 6/12 selected correctly that they would do so 1 week preop. 5/22(22.72%) selected correctly that they would restart at 2 weeks post op.
There is a lack of knowledge around the recommended cessation and recommencement of rheumatologic medications in the perioperative period. 25% of candidates stated they would use local guidelines to aid decision making, however, none exist. While most candidates answered incorrectly across all questions, a significant portion also answered outright that they did not know the answer for the biologic agents, highlighting a need for education. Better awareness of guidelines may lead to better perioperative management and mitigate the risks and complications related to these medications in surgical patients. Information at a ward level/local guidelines may provide this.