Does rheumatoid arthritis affect the infection and complications rates of spinal surgery? a systematic review and meta analysis.

BACKGROUND Rheumatoid arthritis (RA) is a chronic autoimmune disease that produces synovial membrane inflammation and causes progressive articular damage with function lossing. There is some controversy about whether RA is associated with infection and complications after spinal surgery. This study aims to determine the effect of RA on spinal surgery infection and complications. METHODS A systematic literature search was performed according to PRISMA guidelines. All studies that compared patients who underwent spinal operation with and without RA were included in the analysis. RESULTS There were statistically significant higher rates of complications (OR 1.43, 95% CI 1.20-1.70, p < 0.05) and infections (OR 1.69, 95% CI 1.46-1.95, p <0.05) in RA than in non-RA patients undergoing spinal surgery. When registry data were excluded, the study suggested that complications and infections were still higher in the patients with RA than in the non-RA patient groups, (OR 2.24, 95% CI 0.92-5.44, p = 0.08) and (OR 1.76, 95% CI 1.50-2.07,p < 0.05) respectively. CONCLUSION When undergoing spinal surgery, patients with RA are at higher risks of operative complications and infection. Surgeons should be aware of these risks and appropriately plan spinal operation for patients with RA, in order to reduce the risks of complications.