Surgery

Lupus can attack any part of the body, including the major organs and joints. Management of the disease using a combination of drugs and lifestyle changes remain the first choice for treatment.^1-3

However, some people with lupus may need major surgery to repair or replace damaged organs or joints when other treatments no longer work. Minor surgery may be required to diagnose certain problems associated with lupus.^1-3

Major surgeries for lupus

The 3 types of major surgery that people with lupus most often undergo are:^1-3

• Kidney transplant, in people with end-stage renal failure due to kidney nephritis
• Splenectomy (removal of the spleen), to reverse consistently low platelet count (thrombocytopenia)
• Joint replacement, especially hip replacement, to improve mobility and reduce pain when lupus permanently damages the joints

Some surgeries are only performed when lupus has been in remission for a certain amount of time to increase the chances of success.

Minor surgeries for lupus

Your doctor may order a biopsy to diagnose or measure the seriousness of a symptom. A biopsy is a medical procedure where a small piece of tissue is removed and tested. Skin, kidney, and lymph node biopsies are fairly common when someone has lupus.^1-3

Post-surgery complications are common

Many studies from around the world confirm that people with lupus suffer more problems during, and after surgery than the general population.

One US study found that 43 percent of patients with lupus experienced post-surgery complications compared to 30 percent of those without lupus. The most common complications were E. coli infection and acute kidney injury. The study also found that 6 percent of people with lupus died within 30 days of surgery versus one percent of those without lupus.¹

A similar study from Taiwan found that people with lupus who had been in the hospital six months before their surgery were most likely to experience these complications within 30 days of surgery:²

• Kidney failure
• Pneumonia
• Pulmonary embolism (blood clot in the lungs)
• Septicemia (blood poisoning)
• Stroke (blood clot in the brain)

Preparing for surgery with lupus

To reduce these risks, doctors who operate on people with lupus must take special precautions before, during, and after the surgery. It is also vital that the surgery team coordinate with your rheumatologist and other specialists to ensure the best possible outcome.³

Additional tests

Your surgeon will also want to run extra tests to understand whether you have any organ damage, or cardiovascular or blood issues that are likely to impact the surgery. During your post-surgery care, you will be monitored very closely for blood clots in the legs, brain, or lungs (deep vein thrombosis, stroke, or pulmonary embolism).³

Common precautions

A common precaution would be for someone with lupus to stop or start certain medicines before and after surgery. One example would be to stop taking anticoagulants before surgery because these drugs increase the risk of uncontrolled bleeding. You also may need to stop taking steroids 2 days to 2 weeks before surgery. These recommendations may be different for each person, depending on your surgery and health history. Talk with your surgeon for your specific instructions on medication use.⁴

Remembering medications

It can be hard to remember when to stop and start taking different medicines. A printed or online calendar or chart can help you keep track. Remember to let your doctors know about any over-the-counter supplements you take because some can cause increased bleeding or interact with anesthesia.⁴

Surgery is stressful for even the healthiest of people. Despite the extra risks, many people with lupus find that their surgery goes well and improves their quality of life.