Opioid Use Is Associated with Increased Risk of Sepsis and Joint Stiffness in Patients with Pyogenic Flexor Tenosynovitis

Objectives The purpose of this study was to evaluate outcomes of patients with pyogenic flexor tenosynovitis with a history of opioid use disorder. Methods This study utilized the TriNetX database to identify patients aged > 18 years with a history of pyogenic flexor tenosynovitis by CPT code 26020 between January 1, 2015, and January 1, 2025. Concurrent diagnosis of OUD differentiated the experimental group from the control, which could not account for the route of administration. Next, one-to-one propensity matching was performed to balance the groups based on demographic characteristics and comorbidities, returning 734 matched pairs. Outcomes were assessed at one month following the incidence of PFT using relative risk (RR) and 95% confidence intervals (CI). P-value < 0.05 reflects statistical significance. Results Patients with PFT and a history of opioid use disorder were at increased risk of sepsis (RR 2.22, 95% CI (1.286, 3.839)) and joint stiffness (RR incalculable due to no instances of outcome in the control group). There were no differences in amputation rate, repeat irrigation and debridement, contracture, or osteomyelitis. Conclusion Pyogenic flexor tenosynovitis is associated with increased risk of sepsis and joint stiffness in patients with opioid use disorder. Given the higher risk of sepsis, patients with a history of OUD presenting with PFT should follow the respective hospital’s sepsis algorithm and protocol. Likewise, early initiation of hand therapy may be considered to reduce the risk of permanent stiffness.