Disease-modifying anti-rheumatic drugs are associated with increased readmission and reoperation rates following anterior cervical discectomy and fusion: a propensity-matched cohort study.

Background: Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that compromises joint integrity, often necessitating surgical interventions such as anterior cervical discectomy and fusion (ACDF). However, the impact of disease-modifying anti-rheumatic drug (DMARD) therapy on ACDF outcomes remains unclear, particularly with respect to short-term and long-term postoperative complications. Methods: This retrospective propensity-matched cohort study utilized the TriNetX research network to identify adult patients with RA who underwent primary ACDF within the past 20 years. Patients were divided into two cohorts based on perioperative DMARD use. Two matched cohorts of 507 patients each were analyzed (mean age 60 years; 70% female in the DMARD group and 68% female in the non-DMARD group). Primary outcomes included medical complications at 90 days and surgical site and implant-related complications at both 90 days and 2 years postoperatively, including readmission and reoperation rates. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Kaplan-Meier survival analysis was performed to evaluate reoperation-free survival, with statistical significance set at P<0.05. Results: RA patients on DMARD therapy experienced significantly higher rates of 90-day readmission (4.3% Conclusions: DMARD therapy in RA patients undergoing ACDF is associated with increased risks of readmission and reoperation. These findings suggest that while DMARDs provide symptomatic and disease-modifying benefits in RA, their perioperative use may adversely affect surgical durability. Careful consideration of these risks and benefits is warranted when managing RA patients undergoing ACDF.