Effects of Perioperative Antiinflammatory and Immunomodulating Therapy on Surgical Wound Healing

Anthony J. Busti, PharmD; Justin S. Hooper, PharmD; Christopher J. Amaya, PharmD; Salahuddin Kazi, MBBS

Disclosures

Pharmacotherapy. 2005;25(11):1566-1591. 

In This Article

Additional Risk Factors for Poor Postoperative Outcome

A number of factors other than drug therapy may be important in assessing postoperative risk of impaired wound healing. Providers should take age, nutritional state, and smoking status into consideration when treating patients with autoimmune diseases during the perioperative setting. In particular, patients with rheumatoid arthritis may already be at increased risk of impaired wound healing because of a reduction in skin thickness that occurs independently of corticosteroid use. Patients with rheumatoid arthritis are also generally at greater risk of infection[143,144] and vasculitis.[145,146] The presence of diabetes mellitus may predispose patients to infection, typically from compromised microvascular blood flow and higher serum glucose levels, which may impair the ability of neutrophils to fight infection.[147,148,149] Immuno-suppressed patients, such as those who are positive for the human immunodeficiency virus or are treated with chemotherapy, will undoubtedly experience increased rates of infection. Peripheral arterial disease may also contribute to poor wound healing because of a reduction in blood flow and tissue perfusion. Patients who are deficient in vitamin C[130] or are taking other drugs such as anticoagulants,[150] tetracycline,[151] or erythromycin[131] are predisposed to infection.

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