The University of Chicago Pritzker School of Medicine, Chicago, IL.
Northwestern University Feinberg School of Medicine, Chicago, IL.
Spine (Phila Pa 1976). 2020 Jun 15;45(12):837-842. doi: 10.1097/BRS.0000000000003405.
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.
回顾性数据库研究。
本研究旨在探讨择期腰椎融合患者术前使用阿片类药物与术后需要手术冲洗伤口的感染之间的关系。
许多经过同行评审的出版物对手术部位感染的危险因素进行了多变量分析。然而，很少有研究探讨术前使用阿片类药物的情况。阿片类药物已广泛用于术前疼痛管理，但它们对术后感染的影响目前尚无定论。
我们回顾性地查询了 PearlDiver 国家保险索赔数据库，并纳入了 2007 年至 2017 年有腰椎融合病史的患者。任何椎间融合史均被指定为排除项。我们根据单节段或多节段手术对患者进行分层，并对先前记录的感染危险因素以及我们关注的变量，即慢性术前阿片类药物使用进行了单变量分析。与 90 天内术后感染（需要手术冲洗和伤口清创治疗）相关的变量（P<0.100）被纳入多变量分析。
共有 12519 名患者符合我们的纳入标准。在单节段队列中，只有糖尿病与需要手术冲洗伤口的感染有关，因此没有进行进一步的回归分析。对于接受多节段融合的患者队列，慢性阿片类药物使用、糖尿病、充血性心力衰竭、慢性阻塞性肺疾病和高血压在单变量分析中呈显著趋势，并被纳入逻辑回归模型。在多变量分析中，慢性阿片类药物使用（比值比[OR] = 1.435，P = 0.025）、糖尿病（OR = 1.591，P = 0.003）和充血性心力衰竭（OR = 1.929，P = 0.003）被确定为需要手术冲洗伤口的感染的独立危险因素。
在本分析中，术前使用阿片类药物与多节段腰椎融合患者需要手术冲洗伤口的感染显著相关。限制阿片类药物的使用可能有助于降低脊柱手术后感染的风险。
3 级。
