Association between perioperative opioid consumption and postoperative outcomes in lung cancer surgery: evidence from a retrospective study with inflammatory and immune biomarker analysis.

Opioids are crucial for lung cancer postoperative analgesia, but perioperative dosage-inflammation/immunity associations remain unclear. This study explores perioperative opioid use and inflammation/immunity biomarker changes in lung cancer surgery patients. This retrospective study enrolled 412 patients who underwent lung cancer surgery (Jan 2022 - Jan 2025), with clinical data extracted from medical records. Primary outcomes include perioperative opioid morphine equivalent doses, postoperative 72-h C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and immunoglobulin (Ig) A, IgG, IgM, CD4+/CD8+, natural killer (NK) cells; postoperative clinical outcomes include postoperative hospital stay duration, pain score at 72 hours postoperatively, first postoperative ambulation time, gastrointestinal function recovery time, and complications within 30 days postoperatively. Spearman's rho analyzed opioid-biomarker relationships; multivariate regression identified independent risk factors. Among 412 patients, the perioperative opioid morphine equivalent dose was 81.5 (52.15, 116.78) mg. Patients were stratified into four groups (n=103 each), low-dose (≤52.15 mg), low-medium dose (52.15-81.5 mg), medium-high dose (81.5-116.78 mg), and high-dose (>116.78 mg). With increasing opioid dosage, CRP, IL-6, TNF-α significantly elevated; IgA, IgG, IgM, CD4+/CD8+, NK cells significantly decreased (all <0.001). Clinically, postoperative hospital stay duration prolonged, first postoperative ambulation and gastrointestinal function recovery time delayed, complication rates increased (all <0.001), while 72-h postoperative pain scores significantly reduced (<0.001). Pulmonary infection (=0.009) and nausea/vomiting (=0.020) showed significant intergroup differences. Spearman's rho analysis revealed morphine equivalent dose was positively correlated with CRP, IL-6, TNF-α (all <0.001) and negatively correlated with IgA, IgG, IgM, CD4+/CD8+, NK cells (all <0.001). Multivariate regression identified morphine equivalent dose as an independent risk factor for elevated CRP, IL-6, TNF-α and reduced CD4+/CD8+, NK cells at 72 h postoperatively. Perioperative opioid dosage correlates with inflammation/immunity biomarkers in lung cancer surgery. Clinicians should adjust perioperative opioids to reduce dependence and improve outcomes.