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-2x^{2}+\frac{18}{\left(x^{2}+9\right)^{2}}
Factor x^{4}+18x^{2}+81.
\frac{-2x^{2}\left(x^{2}+9\right)^{2}}{\left(x^{2}+9\right)^{2}}+\frac{18}{\left(x^{2}+9\right)^{2}}
To add or subtract expressions, expand them to make their denominators the same. Multiply -2x^{2} times \frac{\left(x^{2}+9\right)^{2}}{\left(x^{2}+9\right)^{2}}.
\frac{-2x^{2}\left(x^{2}+9\right)^{2}+18}{\left(x^{2}+9\right)^{2}}
Since \frac{-2x^{2}\left(x^{2}+9\right)^{2}}{\left(x^{2}+9\right)^{2}} and \frac{18}{\left(x^{2}+9\right)^{2}} have the same denominator, add them by adding their numerators.
\frac{-2x^{6}-36x^{4}-162x^{2}+18}{\left(x^{2}+9\right)^{2}}
Do the multiplications in -2x^{2}\left(x^{2}+9\right)^{2}+18.
\frac{-2x^{6}-36x^{4}-162x^{2}+18}{x^{4}+18x^{2}+81}
Expand \left(x^{2}+9\right)^{2}.