腰椎间盘切除术是一种常见的手术，适用于患有类风湿性关节炎（RA）的患者。RA是一种自身炎症性疾病，可能会使患者更容易出现术后不良结果。本研究使用2010至2020年的MSpine PearlDiver数据库进行回顾性队列研究，评估了患有RA与没有RA的腰椎间盘切除术后不良事件的相对概率。在排除18岁以下的患者、在腰椎间盘切除术前一个月内被诊断为任何创伤、肿瘤或感染等情况，以及在同一天接受任何其他腰椎手术的患者后，我们共鉴定了36,479名腰椎间盘切除术患者。其中2,937名（8.1％）先前被诊断为患有类风湿性关节炎。根据患者年龄、性别和Elixhauser并发症指数（ECI）进行1：4的匹配后，纳入了8,485名没有类风湿性关节炎和2,149名有类风湿性关节炎的腰椎间盘切除患者。在腰椎间盘切除术后90天内严重和轻微的不良事件发生率、预测术后90天内不良事件的预测因素、患者用药方案分层的腰椎间盘切除术后90天不良事件风险、腰椎间盘切除术后5年再次手术的生存率，均需要评估。本研究发现，与没有类风湿性关节炎的患者相比，患有类风湿性关节炎的患者在任何不良事件、严重不良事件和轻微不良事件方面的概率更高。根据患者所服用药物的强度分层，患有类风湿性关节炎的患者出现所有不良事件的概率逐渐增加。然而，在随后的腰椎手术的5年生存率方面，患有类风湿性关节炎的患者与没有类风湿性关节炎的患者之间没有显著差异。因此，在考虑腰椎间盘切除术时，应特别考虑并监测患有类风湿性关节炎的患者。版权所有©2023。由Elsevier Inc.发表。

Lumbar discectomy is a common procedure for which patients with RA may be considered. RA is an autoinflammatory disease that may predispose patients to postoperative adverse outcomes.To assess the relative odds of adverse events after lumbar discectomy for those with versus without rheumatoid arthritis (RA) in a large, national, administrative dataset.Retrospective cohort study using the 2010 to 2020 MSpine PearlDiver dataset.After exclusion of patients under 18 years old, those with any trauma, neoplasm, or infection diagnosis within the month prior to lumbar discectomy, and any patients who had any alternative lumbar spinal surgery performed on the same day as lumbar discectomy, we identified 36,479 lumbar discectomy patients. 2,937 (8.1%) of these patients had a prior diagnosis of rheumatoid arthritis. After matching 4:1 by patient age, sex, and Elixhauser Comorbidity Index (ECI, a longitudinal measure of patient comorbidity burden generated via ICD-9 and 10 diagnosis codes), 8,485 lumbar discectomy patients without rheumatoid arthritis and 2,149 with rheumatoid arthritis were included.Incidence of severe and minor adverse events in the 90-days following lumbar discectomy, predictive factors for adverse events within 90-days of lumbar discectomy, risk of adverse events within 90-days of lumbar discectomy stratified by patient medication regimen, 5-year survival to reoperation following lumbar discectomy.Patients undergoing lumbar discectomy were identified from the PearlDiver MSpine dataset. The subset of those with versus without RA were identified and matched 1:4 based on patient age, sex, and Elixhauser Comorbidity Index (ECI) scores. The incidence of 90-day adverse events in the two groups was determined and compared by univariate and multivariate analyses. Subgroup analysis was performed based on RA medications being taken.Matched lumbar discectomy patients with RA (n=2,149) and without RA (n=8,485) were identified. Controlling for patient age, sex, and ECI, those with RA were at significantly higher odds of any (odds ratio [OR] 3.30), severe (OR 2.78), and minor (OR 3.30) adverse events (p<0.0001 for all). Stratifying by medications being taken (and relative to those without RA), there was increasing odds of all adverse events (AAE) based on potency of medications (no biologic or Disease Modifying Antirheumatic Drugs [DMARDs] OR 2.33, DMARDs only OR 3.86, biologic +/- DMARDs OR 5.69 (p<0.0001 for all). Despite this, no statistically significant difference in 5-year survival from subsequent lumbar surgery was found between those with versus without RA (p=0.1000).Lumbar discectomy patients with RA were found to be at significantly higher risk for 90-day adverse events following lumbar discectomy, and this was incrementally greater for those on increasingly suppressive medications. Lumbar discectomy patients with RA bear specific consideration and perioperative monitoring when considered for lumbar discectomy.Copyright © 2023. Published by Elsevier Inc.