Surgeons report a nearly 10...

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By Gina Brockenbrough
July 2008

DENVER — Patients with foot and/or ankle surgical wounds who are taking COX-2 inhibitors may have a significantly higher incidence of delayed wound healing than those not taking the medication, according to new research presented here.

To evaluate the potential impact of COX-2 inhibitors on surgical wound healing, Chad Lamoreaux, MD, and colleagues performed a retrospective study of all foot and ankle patients operated on by a single surgeon using the same wound care plan during a 3-year period. The investigators excluded patients with pre-existing foot and ankle wounds and those with a history of chronic ulcers.

The results were presented at the American Orthopaedic Foot and Ankle Society 24th Annual Summer Meeting.

Of the 175 patients included in the study, 12.6% had delayed wound healing, which the investigators defined as a postoperative delay, infection, wound sloth or lesion that was followed for a period in the wound care clinic. Of the total study group, 18 patients were on preoperative standing doses of COX-2 medications, which included either celecoxib or rofecoxib.

The investigators discovered that nine of the 18 patients taking a COX-2 inhibitor had delayed wound complications compared to only 13 of the 157 non-COX-2 patients. While the groups were similar regarding demographics such as age and gender, a closer examination revealed a non-equal distribution of patients with diabetes and tobacco use.

After excluding patients with these risk factors, the investigators found that only six of the remaining 150 non-COX-2 patients had wound-healing complications (4%) compared to four out of the 13 remaining COX-2 patients (31%).

"[We] did make several assumptions to do this paper," Lamoreaux said during his presentation. "The distribution of Celebrex (celecoxib, Pfizer) vs. Bextra (valdecoxib, Pfizer) was not looked at. Also, the usage of the nonspecific anti-inflammatories was not looked at. But with the normal patients, our findings still showed a very significant impact of COX-2s on their ability to heal their surgical wounds."

For more information:

Lamoreaux C, Santrock RD and Deemer J. COX-2 inhibitors and wound healing complications. Presented at the American Orthopaedic Foot and Ankle Society 24th Annual Summer Meeting. June 26-28, 2008. Denver.