Surgical-site complications associated with a morphine nerve paste used for postoperative pain control after laminectomy

OBJECTIVE: To identify risk factors that might explain a sudden increase in the rate of surgical-site complications following laminectomy. DESIGN: Retrospective cohort study. PATIENTS AND SETTING: Patients who underwent laminectomy at a 120-bed hospi tal from August 1 through October 15, 1996 (the epidemic period). A case-pa tient was defined as a patient with postoperative surgical-site complicatio ns (surgical-site drainage, edema, or swelling) requiring surgical debridem ent. RESULTS: Of the 148 patients who underwent a laminectomy during the epidemi c period, 17 (11%) met our case definition. The rate of postoperative surgi cal debridement was 7.6-fold higher during the epidemic period than the pre ceding 19-month period (17/148 vs 15/995, P<.001). Development of surgical- site complications was associated with intraoperative receipt of morphine n erve paste (relative risk [RR], 11; P<.001), preoperative shaving by nurses rather than surgeons (RR, 6.6; P=.006), procedures done by a certain surge on (RR 3.1; P=.022), or receipt of iodine rather than povidone-iodine for p reoperative skin antisepsis (RR 5.1; P=.002). In multivariate analysis, onl y receipt of morphine nerve paste remained as a risk factor (RR, 18; P=.011 ). The paste was used to control postoperative pain and was applied directl y to exposed dura and surrounding tissues. At the time of surgical debridem ent (median, 24 days postsurgery), the original surgical sites showed resid ual paste and a lack of healing. Ten of 16 cultures from surgical sites wer e positive; all but three grew skin commensals. Histological examination of surgical specimens showed a foreign-body reaction, but no marked acute inf lammation. CONCLUSIONS: The intraoperative use of morphine nerve paste may delay wound healing and increase postoperative morbidity. When new products are introd uced, standardized protocols should be developed for their use, and systema tic surveillance should be done to monitor for potential adverse outcomes.