Impact of Rheumatoid Arthritis on Postoperative Outcomes Following Lumbar Spine Surgery: A Systematic Review and Meta-Analysis.

Abstract

This systematic review and meta-analysis critically evaluated the impact of rheumatoid arthritis (RA) on postoperative outcomes following lumbar spine surgery. A comprehensive literature search was performed across multiple electronic databases from January 2010 to October 2025. Studies involving adult patients with confirmed RA undergoing lumbar spine surgery with comparator groups were included. Eight retrospective cohort studies representing diverse populations were analyzed. Pooled analysis revealed that patients with RA had a significantly higher risk of reoperation compared to non-RA patients, with a relative risk (RR) of 1.34 and a 95% confidence interval (CI) of 1.15-1.57, though high heterogeneity was noted. Surgical site infection analysis demonstrated a 45% increased risk in RA patients with an RR of 1.45 and a 95% CI of 1.28-1.65, with no heterogeneity observed. Other clinical outcomes, including mortality, pneumonia, acute kidney injury, and sepsis, showed no statistically significant differences between the groups. Patients with RA face significantly elevated risks of reoperation and surgical site infection following lumbar spine surgery, likely due to compromised bone quality, impaired healing capacity, and immunosuppressive medications. These findings have important implications for preoperative counseling and perioperative risk stratification. Future prospective research with detailed characterization of disease activity and medication use is needed to facilitate individualized risk assessment.