{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T03:33:58Z","timestamp":1792985638090,"version":"4.5.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil","award":["Finance code 001"],"award-info":[{"award-number":["Finance code 001"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Rheumatol Int"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Population-level evidence on postoperative outcomes in systemic lupus erythematosus (SLE) remains limited.\u00a0To compare postoperative outcomes between patients with SLE and matched controls and identify factors associated with complications and algorithm-defined disease reactivation.\u00a0We conducted a nationwide retrospective matched cohort study using DATASUS data. Patients with SLE were matched 1:5 to controls by sex, age group, geographic macro-region, preoperative surgical risk, and surgical category. Postoperative outcomes were assessed over 180 days. Multivariable analyses assessed factors associated with outcomes within the SLE cohort. Sensitivity analyses comprised restriction to elective procedures and exclusion of patients classified with cutaneous lupus.\u00a0The cohort included 1,708 patients with SLE and 8,540 controls. SLE was associated with increased risks of surgical (RR 2.20, 95% CI 1.91\u20132.54), clinical (RR 3.30, 95% CI 2.53\u20134.30), infectious (RR 3.66, 95% CI 2.88\u20134.64), and other procedure- or care-related complications (RR 11.33, 95% CI 6.19\u201320.76). Among patients undergoing obstetric procedures, SLE was associated with obstetric complications (RR 1.87, 95% CI 1.37\u20132.54). Within the SLE cohort, cardiovascular risk was independently associated with higher odds of clinical (adjusted OR 2.75, 95% CI 1.36\u20135.54) and other procedure- or care-related complications (adjusted OR 5.46, 95% CI 1.84\u201316.18). Associations between SLE and surgical, clinical, and infectious complications remained significant in both sensitivity analyses. Algorithm-defined SLE reactivation occurred in 3.3%.\u00a0Patients with SLE had higher risks of several postoperative complications than matched controls. The contributions of disease activity and immunosuppressive treatment warrant further investigation.<\/jats:p>","DOI":"10.1007\/s00296-026-06316-9","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:45:17Z","timestamp":1791535517000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Higher postoperative complication rates in patients with systemic lupus erythematosus undergoing surgical and obstetric procedures: a nationwide retrospective matched cohort study"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6553-4634","authenticated-orcid":false,"given":"Francisco Eduardo","family":"Silva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2264-0442","authenticated-orcid":false,"given":"Mirhelen Mendes","family":"de Abreu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"issue":"10188","key":"6316_CR1","doi-asserted-by":"publisher","first-page":"2344","DOI":"10.1016\/S0140-6736(19)30546-X","volume":"393","author":"T D\u00f6rner","year":"2019","unstructured":"D\u00f6rner T, Furie R (2019) Novel paradigms in systemic lupus erythematosus. Lancet (London England) 393(10188):2344\u20132358. https:\/\/doi.org\/10.1016\/S0140-6736(19)30546-X","journal-title":"Lancet (London England)"},{"key":"6316_CR2","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.1136\/annrheumdis-2012-202758","volume":"73","author":"JA Lin","year":"2014","unstructured":"Lin JA, Liao CC, Lee YJ, Wu CH, Huang WQ, Chen TL (2014) Adverse outcomes after major surgery in patients with systemic lupus erythematosus: a nationwide population-based study. Ann Rheum Dis 73:1646\u20131651. https:\/\/doi.org\/10.1136\/annrheumdis-2012-202758","journal-title":"Ann Rheum Dis"},{"issue":"4","key":"6316_CR3","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1213\/ANE.0000000000001911","volume":"124","author":"A Turan","year":"2017","unstructured":"Turan A, Zimmerman NM, Leung SM, Yilmaz HO, Babazade R (2017) Systemic lupus erythematosus is associated with increased adverse postoperative renal outcomes and mortality: a historical cohort study using administrative health data. Anesth Analgesia 124(4):1118\u20131126. https:\/\/doi.org\/10.1213\/ANE.0000000000001911","journal-title":"Anesth Analgesia"},{"key":"6316_CR4","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s11239-017-1591-0","volume":"45","author":"NR Smilowitz","year":"2018","unstructured":"Smilowitz NR, Katz G, Buyon JP et al (2018) Systemic lupus erythematosus and the risk of perioperative major adverse cardiovascular events. J Thromb Thrombolysis 45:13\u201317. https:\/\/doi.org\/10.1007\/s11239-017-1591-0","journal-title":"J Thromb Thrombolysis"},{"issue":"12","key":"6316_CR5","doi-asserted-by":"publisher","first-page":"1960","DOI":"10.1177\/0961203318799188","volume":"27","author":"L Quintanilla-Gonz\u00e1lez","year":"2018","unstructured":"Quintanilla-Gonz\u00e1lez L, Torres-Villalobos G, Hinojosa-Azaola A (2018) Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery. Lupus 27(12):1960\u20131972. https:\/\/doi.org\/10.1177\/0961203318799188","journal-title":"Lupus"},{"key":"6316_CR6","doi-asserted-by":"publisher","first-page":"e20233545","DOI":"10.1590\/0100-6991e-20233545-en","volume":"50","author":"SW Viana","year":"2023","unstructured":"Viana SW, Faleiro MD, Mendes ALF, Torquato AC, Tavares CPO, Feres B, Fernandez MG, Sobreira IRM, Aquino CM, Abib SCV, Botelho F (2023) Limitations of using the DATASUS database as a primary source of data in surgical research: a scoping review. Rev Col Bras Cir 50:e20233545. https:\/\/doi.org\/10.1590\/0100-6991e-20233545-en","journal-title":"Rev Col Bras Cir"},{"issue":"1","key":"6316_CR7","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1590\/s0102-311x2006000100003","volume":"22","author":"SA Bittencourt","year":"2006","unstructured":"Bittencourt SA, Camacho LA, Leal MC (2006) O Sistema de Informa\u00e7\u00e3o Hospitalar e sua aplica\u00e7\u00e3o na sa\u00fade coletiva [Hospital Information Systems and their application in public health]. Cad Saude Publica 22(1):19\u201330. https:\/\/doi.org\/10.1590\/s0102-311x2006000100003","journal-title":"Cad Saude Publica"},{"key":"#cr-split#-6316_CR8.1","unstructured":"Ministry of Health (Brazil) (2013) Clinical Protocol and Therapeutical Guidelines-systemic lupus erythematosus. Ministry of Health, Bras\u00edlia (DF). Portaria SAS\/MS n\u00ba 100, February 7, 2013. Di\u00e1rio Oficial da Uni\u00e3o 2013"},{"key":"#cr-split#-6316_CR8.2","unstructured":"Sect. 1:70-75. https:\/\/www.gov.br\/conitec\/pt-br\/midias\/protocolos\/lupuseritematoso_sistemico-1.pdf. Accessed 31 Mar 2023"},{"key":"#cr-split#-6316_CR9.1","unstructured":"Ministry of Health (Brazil) (2022) Clinical Protocol and Therapeutical Guidelines-systemic lupus erythematosus. Ministry of Health, Bras\u00edlia (DF). Portaria SCTIE\/MS n\u00ba 43, September 28, 2022. Di\u00e1rio Oficial da Uni\u00e3o 2022 Sep 29"},{"key":"#cr-split#-6316_CR9.2","unstructured":"Sec 1:123-6.. https:\/\/www.gov.br\/conitec\/pt-br\/midias\/protocolos\/pcdt_lupus_eritematoso_sistemico_2022.pdf. Accessed 31 Mar 2023"},{"issue":"3 Suppl 1","key":"6316_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5935\/abc.20170140","volume":"109","author":"DM Gualandro","year":"2017","unstructured":"Gualandro DM, Yu PC, Caramelli B, Marques AC, Calderaro D, Fornari LS, Pinho C, Feitosa ACR, Polanczyk CA, Rochitte CE, Jardim C, Vieira CLZ, Nakamura DYM, Iezzi D, Schreen D, Adam EL, D\u2019Amico EA, Lima EQ, Burdmann EA, Mateo EIP et al (2017) 3rd Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology. Arq Bras Cardiol 109(3 Suppl 1):1\u2013104. https:\/\/doi.org\/10.5935\/abc.20170140","journal-title":"Arq Bras Cardiol"},{"issue":"1","key":"6316_CR11","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.bpa.2020.12.005","volume":"35","author":"S Kivrak","year":"2021","unstructured":"Kivrak S, Haller G (2021) Scores for preoperative risk evaluation of postoperative mortality. Best Pract Res Clin Anaesthesiol 35(1):115\u2013134. https:\/\/doi.org\/10.1016\/j.bpa.2020.12.005","journal-title":"Best Pract Res Clin Anaesthesiol"},{"issue":"6","key":"6316_CR12","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1002\/acr.21915","volume":"65","author":"A Yazdanyar","year":"2013","unstructured":"Yazdanyar A, Wasko MC, Scalzi LV, Kraemer KL, Ward MM (2013) Short-term perioperative all-cause mortality and cardiovascular events in women with systemic lupus erythematosus. Arthritis Care Res (Hoboken) 65(6):986\u2013991. https:\/\/doi.org\/10.1002\/acr.21915","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"6","key":"6316_CR13","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1002\/acr2.11424","volume":"4","author":"S Bruera","year":"2022","unstructured":"Bruera S, Lei X, Blau B, Zhao H, Deswal A, Yazdany J, Giordano SH, Suarez-Almazor ME (2022) Postoperative major adverse cardiac events in patients with systemic lupus erythematosus. ACR Open Rheumatol 4(6):511\u2013519. https:\/\/doi.org\/10.1002\/acr2.11424","journal-title":"ACR Open Rheumatol"},{"issue":"11","key":"6316_CR14","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1002\/jhbp.70004","volume":"32","author":"SC Luo","year":"2025","unstructured":"Luo SC, Chang KH, Su TC, Hsieh HY, Shih YH, Lin HC, Chou MC (2025) Impact of systemic lupus erythematosus (SLE) on short-term outcomes of cholecystectomy for acute cholecystitis: an analysis of the US National Readmission Database, 2016\u20132020. J Hepatobiliary Pancreat Sci 32(11):829\u2013837. https:\/\/doi.org\/10.1002\/jhbp.70004","journal-title":"J Hepatobiliary Pancreat Sci"},{"issue":"8","key":"6316_CR15","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1007\/s00296-009-1323-7","volume":"30","author":"P H\u00e4rle","year":"2010","unstructured":"H\u00e4rle P, Straub RH, Fleck M (2010) Perioperative management of immunosuppression in rheumatic diseases - what to do? Rheumatol Int 30(8):999\u20131004. https:\/\/doi.org\/10.1007\/s00296-009-1323-7","journal-title":"Rheumatol Int"},{"issue":"2","key":"6316_CR16","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1007\/s00296-014-3121-0","volume":"35","author":"Z Abou Zahr","year":"2015","unstructured":"Abou Zahr Z, Spiegelman A, Cantu M, Ng B (2015) Perioperative use of anti-rheumatic agents does not increase early postoperative infection risks: a Veteran Affairs\u2019 administrative database study. Rheumatol Int 35(2):265\u2013272. https:\/\/doi.org\/10.1007\/s00296-014-3121-0","journal-title":"Rheumatol Int"},{"issue":"3","key":"6316_CR17","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1007\/s00296-018-4234-7","volume":"39","author":"JM L\u00f3pez-Morales","year":"2019","unstructured":"L\u00f3pez-Morales JM, Quintanilla-Gonz\u00e1lez L, Ram\u00edrez-Sandoval JC, Hinojosa-Azaola A (2019) Early outcomes in kidney transplant recipients with systemic lupus erythematosus. Rheumatol Int 39(3):479\u2013487. https:\/\/doi.org\/10.1007\/s00296-018-4234-7","journal-title":"Rheumatol Int"},{"issue":"6","key":"6316_CR18","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1007\/s00296-024-05564-x","volume":"44","author":"P Elfving","year":"2024","unstructured":"Elfving P, Kariniemi S, Kautiainen H, Rantalaiho V, Virta LJ, Puolakka K, Laine MK (2024) Pregnancies in patients with systemic lupus erythematosus during 2000\u20132018 in Finland: a case-control study. Rheumatol Int 44(6):1101\u20131109. https:\/\/doi.org\/10.1007\/s00296-024-05564-x","journal-title":"Rheumatol Int"},{"key":"6316_CR19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.03.012","author":"ME Clowse","year":"2008","unstructured":"Clowse ME, Jamison M, Myers E, James AH (2008) A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. https:\/\/doi.org\/10.1016\/j.ajog.2008.03.012","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"6316_CR20","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1016\/j.semarthrit.2020.01.014","volume":"50","author":"YJ Chen","year":"2020","unstructured":"Chen YJ, Chang JC, Lai EL, Liao TL, Chen HH, Hung WT, Hsieh TY, Huang WN, Chen YH, Lin CH, Chen YM (2020) Maternal and perinatal outcomes of pregnancies in systemic lupus erythematosus: a nationwide population-based study. Semin Arthritis Rheum 50(3):451\u2013457. https:\/\/doi.org\/10.1016\/j.semarthrit.2020.01.014","journal-title":"Semin Arthritis Rheum"}],"container-title":["Rheumatology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00296-026-06316-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00296-026-06316-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00296-026-06316-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T03:02:33Z","timestamp":1792983753000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00296-026-06316-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":22,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["6316"],"URL":"https:\/\/doi.org\/10.1007\/s00296-026-06316-9","relation":{},"ISSN":["1437-160X"],"issn-type":[{"value":"1437-160X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"assertion":[{"value":"10 August 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Research Ethics Committee of Hospital Universit\u00e1rio Clementino Fraga Filho on March 20, 2019 (CAAE 23962819.8.0000.5257). Data were obtained through an official request to DATASUS (protocol no. 25000.134828\/2015-86) and analysed using anonymised patient identifiers.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for informed consent was waived because the study used retrospective, anonymised administrative data.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":4,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No part of this manuscript has been copied from or published elsewhere, and no scientific content, study data, statistical analyses, results, or conclusions were generated by artificial intelligence. The limited use of artificial intelligence for language editing, text organisation, and refinement of author-generated text is disclosed separately in the manuscript. The authors take full responsibility for the content and integrity of this report.","order":5,"name":"Ethics","label":"Disclaimer","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"280"}}