When to resume colchicine (anti-gout medication) after surgery?

Resuming Colchicine After Surgery

Colchicine can be resumed once the surgical wound shows evidence of healing, typically around 14 days after surgery, when all sutures/staples are out, there is no significant swelling, erythema, or drainage, and there is no clinical evidence of infection. 1

Timing Considerations for Resuming Colchicine

• While the American College of Rheumatology guidelines don't specifically mention colchicine, they recommend restarting biologic therapies once wound healing is evident (typically ~14 days post-surgery) 2
• The decision to restart anti-inflammatory medications should be based on careful assessment of wound status and clinical judgment for absence of surgical and non-surgical site infections 2
• Wound closure typically requires approximately 14 days, making this a reasonable timepoint to consider resuming colchicine 2

Rationale for Delayed Resumption

• Colchicine has been shown to delay wound repair in experimental models by inhibiting the infiltration of neutrophils and subsequent macrophage polarization toward the proinflammatory M1 phenotype 3
• Early administration of colchicine may interfere with the normal wound healing process, which requires proper inflammatory cell function 3
• Waiting until wound healing is well-established helps mitigate the risk of wound complications while allowing resumption of treatment for gout 1

Special Considerations

• If the patient is at high risk for gout flares, consider:
  • Monitoring for signs of gout flare during the perioperative period 1
  • Ensuring adequate wound healing before resuming colchicine to avoid compromising surgical outcomes 3
• For patients who were using colchicine for prevention of pericardial or pleural effusions after cardiac surgery, the medication is typically administered for only 1 month post-surgery 4

Potential Benefits of Colchicine in Surgical Patients

• Colchicine has demonstrated efficacy in reducing postpericardiotomy syndrome after cardiac surgery 5
• It can reduce the incidence of postoperative atrial fibrillation in cardiac surgery patients 6
• Colchicine has been shown to prevent postoperative pericardial and pleural effusions 4

Potential Risks and Side Effects

• Gastrointestinal adverse effects are common with colchicine use:
  • Diarrhea (25.7% vs 11.8% in placebo) 6
  • Abdominal pain (7% vs 1.6% in placebo) 6
• These side effects may complicate postoperative recovery and should be monitored 6
• The anti-inflammatory properties of colchicine that make it effective for gout can also potentially delay wound healing 3

Monitoring After Resumption

• After resuming colchicine, monitor for:
  • Signs of wound complications (increased pain, drainage, dehiscence) 3
  • Gastrointestinal side effects that may require dose adjustment 6
  • Efficacy in preventing gout flares 1