Effects of Perioperative Antiinflammatory and Immunomodulating Therapy on Surgical Wound Healing

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Effects of Perioperative Antiinflammatory and Immunomodulating Therapy on

Surgical Wound Healing

Posted 12/02/2005

J. Busti, Pharm.D.; S. Hooper, Pharm.D.; J.

Amaya, Pharm.D.; Salahuddin Kazi, M.B.B.S.

Abstract and Introduction

Abstract

Patients with various rheumatologic and inflammatory disease states commonly

require drugs known to decrease the inflammatory or autoimmune response for

adequate control of their condition. Such drugs include nonsteroidal

antiinflammatory drugs (NSAIDs), cyclooxygenase (COX)-2 inhibitors,

corticosteroids,

disease-modifying antirheumatic drugs (DMARDs), and biologic response

modifiers. These drugs affect inflammation and local immune responses, which

are

necessary for proper wound healing in the perioperative setting, thereby

potentially resulting in undesirable postoperative complications. Such

complications

include wound dehiscence, infection, and impaired collagen synthesis. The

end result is delayed healing of soft tissue and bone wounds. The current

literature

provides insight into the effect of some of these drugs on wound healing.

For certain drugs, such as methotrexate, trials have been conducted in

humans

and direct us on what to do during the perioperative period. Whereas with

other drugs, we must rely on either small-animal studies or extrapolation of

data from human studies that did not specifically look at wound healing.

Unfortunately, no clear consensus exists on the need and optimum time for

withholding

therapy before surgery. Likewise, clinicians are often uncertain of the

appropriate time to resume therapy after the procedure. For those drugs with

limited

or no data in this setting, the use of pharmacokinetic properties and

biologic effects of each drug should be considered individually. In some

cases, discontinuation

of therapy may be required up to 4 weeks before surgery because of the long

half-lives of the drugs. In doing so, patients may experience an

exacerbation

or worsening of disease. Clinicians must carefully evaluate individual

patient risk factors, disease severity, and the pharmacokinetics of

available therapies

when weighing the risks and benefits of discontinuing therapy in the

perioperative setting.

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