From the Guidelines
It is generally recommended to hold methotrexate temporarily after an exploratory laparotomy to minimize the risk of complications, particularly infection and impaired wound healing, as suggested by the British Association of Dermatologists' guidelines 1. The decision to hold methotrexate should be made on a case-by-case basis, taking into account the individual's overall health, comorbidities, and the specific surgical procedure. While there is evidence to suggest that methotrexate can be safely continued in the perioperative period for elective orthopaedic surgery, as noted in the multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders 1, the situation may differ for non-elective non-orthopaedic surgery such as an exploratory laparotomy. Some key points to consider include:
- Methotrexate is an immunosuppressive medication that can increase the risk of infection and impair wound healing, which are significant concerns after abdominal surgery.
- The risk of infection and postoperative complication did not appear to be affected by continuing methotrexate prior to elective orthopaedic surgery in some studies 1.
- However, the lack of studies specifically addressing perioperative methotrexate use in non-elective non-orthopaedic surgery, such as exploratory laparotomy, necessitates a cautious approach.
- The British Association of Dermatologists' guidelines suggest that the decision to continue methotrexate during the perioperative period should be made on a case-by-case basis, particularly for patients with comorbidities that may alter infection risk 1.
- Temporarily stopping methotrexate may cause a mild flare in arthritis symptoms, but this is usually considered an acceptable trade-off to ensure proper surgical recovery. During the hold period, alternative pain management strategies for arthritis symptoms may be recommended by the healthcare provider. Ultimately, the specific timing for resuming methotrexate should be determined by the healthcare provider based on the individual's healing progress, infection risk, and overall recovery.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Holding Methotrexate for Arthritis after Exploratory Laparotomy
- The decision to hold methotrexate for arthritis after an exploratory laparotomy is a complex one, with different studies suggesting different approaches 2, 3.
- Some studies suggest that holding methotrexate for 2 weeks perioperatively may be a reasonable approach to reduce the risk of postoperative infection or poor wound healing 2.
- However, other studies suggest that continuing methotrexate throughout the perioperative period may be safe and may help to avoid flares in rheumatoid arthritis disease activity 3.
- There is no clear consensus on the best approach, and the decision should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.
- It is worth noting that the use of prophylactic antibiotics in patients undergoing exploratory laparotomy is a common practice, and the choice of antibiotic regimen may depend on various factors, including the type of surgery and the patient's underlying medical conditions 4, 5.
- Laparoscopic exploration may be a useful alternative to exploratory laparotomy in some cases, as it may be associated with less trauma and a lower risk of complications 6.