Chronic Opioid Use Is Associated With Surgical Site Infection After Lumbar Fusion.
Adult
Aged
Analgesics, Opioid
/ adverse effects
Cohort Studies
Elective Surgical Procedures
/ adverse effects
Female
Humans
Lumbosacral Region
/ surgery
Male
Middle Aged
Opioid-Related Disorders
/ etiology
Retrospective Studies
Risk Factors
Spinal Fusion
/ adverse effects
Surgical Wound Infection
/ etiology
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Jun 2020
15 Jun 2020
Historique:
pubmed:
8
2
2020
medline:
21
10
2020
entrez:
8
2
2020
Statut:
ppublish
Résumé
Retrospective, database review. The purpose of this study was to explore the association between preoperative opioid use and postoperative infection requiring operative wound washout in elective lumbar fusion patients. Numerous peer-reviewed publications have conducted multivariate analyses of risk factors for surgical site infection. However, few have explored preoperative opioid use. Opioids have been widely prescribed preoperatively for pain management, but their effect on postsurgical infection is currently inconclusive. We retrospectively queried the PearlDiver national insurance claims database and included patients from 2007 to 2017 with a history of lumbar fusion. Any interbody fusion history designated exclusion. We stratified patients by single or multilevel procedures and conducted univariate analyses of previously documented infection risk factors, as well as our variable of interest, chronic preoperative opioid use. Variables associated (P < 0.100) with the outcome measure of 90-day postoperative infection treated with operative irrigation and wound debridement were included in a multivariate analysis. A total of 12,519 patients matched our inclusion criteria. Among the single-level cohort, only diabetes was observed to be associated with infection requiring operative wound washout and thus no subsequent regression was performed. For the cohort of patients who underwent multilevel fusion, chronic opioid use, diabetes, congestive heart failure, chronic obstructive pulmonary disease, and hypertension trended toward significance in the univariate analysis and were included in a logistic regression model. In the multivariate analysis, chronic opioid use (odds ratio [OR] = 1.435, P = 0.025), diabetes (OR = 1.591 P = 0.003), and congestive heart failure (OR = 1.929, P = 0.003) were identified as independent risk factors for infection requiring operative wound washout. In this analysis, preoperative opioid use was significantly associated with infection requiring operative wound washout in multilevel lumbar fusion patients. Limiting opioid consumption may have the benefit of reducing the risk of infection following spine surgery. 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective, database review.
OBJECTIVE
OBJECTIVE
The purpose of this study was to explore the association between preoperative opioid use and postoperative infection requiring operative wound washout in elective lumbar fusion patients.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Numerous peer-reviewed publications have conducted multivariate analyses of risk factors for surgical site infection. However, few have explored preoperative opioid use. Opioids have been widely prescribed preoperatively for pain management, but their effect on postsurgical infection is currently inconclusive.
METHODS
METHODS
We retrospectively queried the PearlDiver national insurance claims database and included patients from 2007 to 2017 with a history of lumbar fusion. Any interbody fusion history designated exclusion. We stratified patients by single or multilevel procedures and conducted univariate analyses of previously documented infection risk factors, as well as our variable of interest, chronic preoperative opioid use. Variables associated (P < 0.100) with the outcome measure of 90-day postoperative infection treated with operative irrigation and wound debridement were included in a multivariate analysis.
RESULTS
RESULTS
A total of 12,519 patients matched our inclusion criteria. Among the single-level cohort, only diabetes was observed to be associated with infection requiring operative wound washout and thus no subsequent regression was performed. For the cohort of patients who underwent multilevel fusion, chronic opioid use, diabetes, congestive heart failure, chronic obstructive pulmonary disease, and hypertension trended toward significance in the univariate analysis and were included in a logistic regression model. In the multivariate analysis, chronic opioid use (odds ratio [OR] = 1.435, P = 0.025), diabetes (OR = 1.591 P = 0.003), and congestive heart failure (OR = 1.929, P = 0.003) were identified as independent risk factors for infection requiring operative wound washout.
CONCLUSION
CONCLUSIONS
In this analysis, preoperative opioid use was significantly associated with infection requiring operative wound washout in multilevel lumbar fusion patients. Limiting opioid consumption may have the benefit of reducing the risk of infection following spine surgery.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 32032322
doi: 10.1097/BRS.0000000000003405
pii: 00007632-202006150-00020
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
837-842Références
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