Presented at the 2012 AAPM Annual Meeting « Back

Chronic Opioid Consumption and Perioperative Infections

Kaveh Nabavighadi, MD, knabavi1@hfhs.org1, Michael Brown, DO2, Kate Polyatskaya, MD3, Ilan Rubinfeld, MD4, Henry Kroll, MD3, David Kim, MD4, (1) Henry Ford Health System, Detroit, Michigan, (2) Fletcher Allen Health Care, University of Vermont, South Burlington, Vermont, (3) Henry Ford Hospital, Detroit, Michigan, (4) Henry Ford Medical Group, Detroit, Michigan

Introduction: Studies suggest opioids negatively modulate the immune system. These drugs have inhibitory effects on antibody/cellular immune response, natural killer, and phagocytic activity. We compared the perioperative infection rate in patients with and without chronic opioid consumption. Materials and Methods: With IRB approval, we conducted retrospective review from 2006 to 2010 of our institution’s data reporting to the National Surgical Quality Improvement Project (NSQIP) for colectomy and lumbar spinal surgery. We supplemented NSQIP variables with chronic opioid intake (defined as ≥90 days). The population consisted of randomly selected patients per NSQIP sampling. Data was analyzed using two sample t-tests, Chi-squared tests for two-by-two tables and multivariate regression. Results: 968 charts were reviewed. 162(16.7%) patients were ingesting opioids chronically. Of 14 factors assessed, there was statistically significant association between the chronic opioid group and diabetes, non-emergent surgery, clean wound classification, and ASA physical status ≥4 (Figure 1). The non-chronic opioid group had statistically significant higher frequency of total infections (p = 0.002) and particularly superficial incisional surgical site infection (p = 0.003) (Figure 2). On multivariate regression of factors analyzed, only contaminated wound class was predictive of superficial surgical site infection (p = 0.044). Conclusions: In our population, patients consuming chronic opioids were less likely to have infection. Surgical technique and operating room environment (glucose, temperature, hypoxia, etc.) may play a larger role than opioid consumption in the occurrence of surgical site infection. Further prospective studies are warranted to elucidate this issue. References: 1)Effects of opioid tolerance and withdrawal on the immune system. Eisenstein TK, Rahim RT, Feng P, Thingalaya NK, Meissler JJ. J Neuroimmune Pharmacol. 2006 Sep;1(3):237-49. Epub 2006 May 23. Review. 2)Opioid therapy and immunosuppression: a review. Vallejo R, de Leon-Casasola O, Benyamin. Am J Ther. 2004 Sep-Oct;11(5):354-65. Review. 3)Chronic exposure of human macrophages in vitro to morphine and methadone induces a putative tolerant/dependent state. Delgado-Vélez M, Lugo-Chinchilla A, Lizardo L, Morales I, Robles Y, Bruno N, Rodríguez JW, Ríos-Olivares E, Correa M, Renaud FL. J Neu

Funding: None