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TOPLINE
Patients with systemic lupus erythematosus (SLE) who underwent abdominal, urologic, pelvic, or obstetric procedures had higher risks for surgical, clinical, obstetric, infectious, and other procedure- or care-related complications than matched control individuals.
METHODOLOGY
- In a retrospective cohort study, researchers used Brazilian health system data to compare complications after surgical procedures between patients with SLE and matched control individuals.
- They included 1708 patients with SLE (approximately 92% women) who underwent abdominal, urologic, pelvic, or obstetric procedures from 2008 to 2018; patients were matched with 8540 matched control individuals who underwent the same categories of procedures.
- Patients with SLE were identified using specific diagnosis codes, records of outpatient care for SLE, and immunosuppressive medication use recorded in the 12 months before surgery.
- Over 180 days after surgery, researchers assessed five complication categories (surgical, clinical, obstetric, infectious, and other procedure- or care-related), covering events such as reoperation, organ failure, sepsis, and miscarriage, along with SLE reactivation defined by an algorithm.
- They also evaluated the association of cardiovascular risk with postoperative complications and reactivation within the SLE group.
TAKEAWAY
- Patients with SLE had higher risks for surgical (risk ratio [RR], 2.20), clinical (RR, 3.30), and infectious (RR, 3.66) complications than matched control individuals (P < .001 for all). Other procedure- or care-related complications were also more frequent (RR, 11.33; P < .001).
- Obstetric complications were more frequent in patients with SLE than in control individuals after obstetric procedures (7.7% vs 4.1%; RR, 1.87; P < .001). SLE reactivation defined based on an algorithm occurred in 3.3% of patients with SLE.
- Patients with SLE had longer mean hospital stays (4.92 vs 3.08 days), more frequent ICU admissions (8.7% vs 3.4%), and higher in-hospital mortality (4.4% vs 0.8%) than control individuals (P < .001 for all).
- Among patients with SLE, cardiovascular risk was associated with higher odds of clinical (adjusted odds ratio [aOR], 2.75; P = .004) and other procedure- or care-related (aOR, 5.46; P = .002) complications.
IN PRACTICE
"[The study] findings identify a higher-risk perioperative profile in this population, while the relative contributions of underlying disease activity and immunosuppressive treatment warrant further investigation," the authors wrote.
SOURCE
The study was led by Francisco Eduardo Silva, Universidade Federal do Rio de Janeiro, Campus Macaé, in Rio de Janeiro, Brazil. It was published online on October 9, 2026, in Rheumatology International.
LIMITATIONS
The study lacked disease activity measures and exposure to treatment, which might have affected estimated risks following surgery. SLE reactivation was defined using an algorithm and cannot be interpreted as a clinically validated disease flare outcome.
DISCLOSURES
The study was supported by the Coordination for the Improvement of Higher Education Personnel, Brazil. The authors reported having no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
