Risk Factors and Risk Stratification of Acute Gout Flares after Orthopedic Surgery

Considering the need for early recognition and appropriate perioperative management of gout to facilitate clinical decision making and improve surgical outcomes and patient prognosis, this study aimed to identify risk factors and establish a predictive model for acute gouty arthritis flares after orthopedic surgery.

This single-center retrospective cohort study included 116 patients who underwent orthopedic surgery during 2021- 2025. The patients were categorized into flare (n = 55) and nonflare (n = 61) groups based on 1-year postoperative outcomes.

Multivariate analysis revealed elevated serum uric acid (odds ratio [OR] = 1.029, P < .05), and greater blood loss (OR = 1.089, P < .05) as independent risk factors, while diabetes mellitus (OR = 0.014, P < .05) and intraoperative fluid infusion volume emerged as independent protective factors. Admission UA showed good predictive value (area under the curve [AUC] = 0.874), whereas the combined model showed high apparent discrimination, with an optimism-corrected AUC of 0.970.

Multiple perioperative factors can help predict postoperative gout flares. Using a combined model yielded high accuracy and could guide early risk stratification and personalized perioperative management. Nonetheless, prospective multicenter studies incorporating mechanistic biomarkers, longer follow-up, and external validation are needed to refine individualized perioperative gout management strategies.