Perioperative Infections: Less Frequent in Patients with Chronic Opioid Consumption?
PALM SPRINGS, CA — Chronic opioid intake of ≥90 days may be associated with fewer perioperative infections; however, surgical technique and operating room environment — glucose, temperature, and hypoxia — “may play a larger role than opioid consumption in the occurrence of surgical site infection,” found a retrospective review of patients undergoing colectomy and lumbar spinal surgery presented during the 2012 American Academy of Pain Medicine Annual Meeting.
Kaveh Nabavighadi, MD, of the Henry Ford Health System, Detroit, MI, and colleagues, examined institutional National Surgical Quality Improvement Project (NSQIP) reporting data from 2006 to 2010, supplemented with chronic opioid-intake data. Patients were randomly selected and the data were analyzed.
Of the 968 charts reviewed, 162 (16.7%) patients were ingesting opioids chronically. Of 14 factors assessed, a statistically significant association was found between the chronic opioid group and diabetes (P=0.024), nonemergent surgery (P=0.002), clean wound classification (P=0.001), and American Society of Anesthesiologists (ASA) physical status ≥4 (P=0.021).
Patients in the nonchronic opioid group had a significantly higher frequency of total infections (P=0.002); specifically, superficial incisional surgical site infection (P=0.003). Multivariate regression revealed that only contaminated wound class was predictive of superficial surgical site infection (P=0.044).
“While our data does show an association with decreased infection, we feel it is unlikely a direct outcome of the opiates and would hesitate to say that opiates are protective, at least without further studies,” Dr. Nabavighadi told MPR. The researchers initially expected the outcome to be the opposite, Dr. Nabavighadi noted.
Two possible causes for this association are superior perioperative analgesia and/or closer follow-up with healthcare, since patients require clinician visits to receive prescriptions for chronic opiates, they concluded.