AUGUST 15, 2024
SAN FRANCISCO—New research has revealed a possible association between chronic opioid use and surgical site infections (SSIs) in patients undergoing abdominal surgery.
The retrospective analysis found that use of opioids for at least six months prior to surgery was related to a significantly higher incidence of SSIs than no opioid use. As such, researchers recommended tapering opioid doses in advance of surgery, which may reduce the risk for these infections.
Reporting at the 2023 annual
SAN FRANCISCO—New research has revealed a possible association between chronic opioid use and surgical site infections (SSIs) in patients undergoing abdominal surgery.
The retrospective analysis found that use of opioids for at least six months prior to surgery was related to a significantly higher incidence of SSIs than no opioid use. As such, researchers recommended tapering opioid doses in advance of surgery, which may reduce the risk for these infections.
Reporting at the 2023 annual meeting of the American Society of Anesthesiologists (abstract A1088), the researchers explained that long-term opioid use has been found to decrease macrophage and lymphocyte precursor cells, potentially leading to decreased pathogen clearing and increased infection rates.
“We wanted to perform this investigation because we found a gap in medical literature relating long-term opioid use and infectious outcomes of common procedures,” said Rovnat Babazade, MD, an associate professor of anesthesiology at The University of Texas Medical Branch, in Galveston. “We chose appendectomies, cholecystectomies and hernia repairs to investigate, as these are the common general surgical procedures performed on a day-to-day basis.”
Babazade and his colleagues (medical students Christy Lee and Shiva Nuti) turned to the TriNetX database to conduct the case–control, propensity-matched study, which examined the incidence of SSIs in patients on chronic opioid therapy who underwent a common abdominal surgery. As part of their database query, the researchers defined chronic opioid therapy as three or more instances of opioid analgesic use in both of the following periods: one day to three months and three to six months prior to surgery. Patients were then matched with a comparable group of patients who did not have long-term preoperative opioid use. The study’s end point was the incidence of SSIs.
After propensity score matching, 8,276 patients were included in each cohort. Results showed that the risk for SSIs was 3.99% among chronic opioid users, compared with 2.04% among their counterparts who did not use opioids (risk ratio, 1.95; 95% CI, 1.65-2.40; P<0.01).
“After controlling variables in both the therapy and control cohorts for age, race, opioid use disorders and long-term immunosuppression use, we found that there was a significant increase of [SSIs] with patients on chronic opioid therapy as compared with the control cohort,” Babazade told Pain Medicine News.
Given these findings, the researchers recommended that clinicians consider tapering opioid doses prior to surgery, a strategy they believe may reduce SSIs.
“However, there is a balance between medication adjustment and surgical outcomes that must be approached in a case-by-case scenario for each patient,” Babazade noted. “For example, pain doctors managing patients that are on heavy opioid regimens for chronic pain may not justify stoppage of medication for an extended time just to minimally decrease the chance of surgical site infections for a simple outpatient surgery.”
Future studies, he added, will seek to include hospital length of stay to further evaluate how long-term opioid use may affect perioperative care. The researchers also hope to use such investigations to determine which opioids lead to an increased likelihood of infection, and when these medications should be discontinued before a scheduled procedure—if at all.
—Michael Vlessides
Babazade reported no relevant financial disclosures.
