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Methylprednisolone Following Distal Radius Repair is Associated with Reduced Long-Term Opioid Prescriptions and Increased Early Postoperative Complications: A Propensity-Matched Analysis
Priyank P. Patel, BS
1, Sehajvir Singh, BS
1, Wali U. Pirzada, BS
2, Simran Shamith, BS
1, Kimberly Dong, BS
2,3, Zachary Demetriou, BS
2,3; Asif M. Ilyas, MD, MBA
1,2,3(1)Drexel University College of Medicine, Philadelphia, PA, (2)Rothman Orthopaedic Institute Foundation for Opioid Research and Education, Philadelphia, PA, (3)Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
Introduction: Effective pain management following distal radius fracture (DRF) treatment with open reduction and internal fixation (ORIF) is crucial for recovery and minimizing opioid reliance. While methylprednisolone has been shown to reduce opioid use, its role in postoperative care after DRF ORIF is not well understood. This study evaluated the impact of methylprednisolone within the immediate postoperative period on opioid use, medical outcomes, and surgical complications following DRF ORIF.
Materials and Methods: The TriNetX Global Collaborative Network database was queried for adult patients, aged 18 years and older, with at least one year of follow-up data. Patients were stratified into two cohorts: those prescribed methylprednisolone within one week postoperatively, and a methylprednisolone-naïve control group. Exclusion criteria included prior methylprednisolone use and absence of healthcare visits within ninety days postoperatively. Cohorts were matched for demographic variables, BMI, comorbidities, nicotine dependence, and medication use with propensity scoring. Postoperative medical outcomes, orthopedic outcomes, and opioid prescription incidences were evaluated at 1 week, 2 weeks, 1 month, and 3 months, with significant differences identified by odds ratios (OR) and p-values (p < 0.05).
Results: A total of 1,828 patients were analyzed after matching, 914 per cohort. At 3 months, the methylprednisolone cohort demonstrated significantly lower mean opioid prescription rates (1.541 vs. 2.142,
p = 0.0152). However, in the early postoperative period, the methylprednisolone group experienced significantly increased complications, including higher rates of hospital readmission at 1 week (OR = 1.326,
p = 0.013) and 2 weeks (OR = 1.292,
p = 0.020), and ED visits at 1 week (OR = 2.229,
p = 0.032). Respiratory failure was more common in the methylprednisolone group at 2 weeks (OR = 2.541,
p = 0.010), 1 month (OR = 2.688,
p = 0.004), and 3 months (OR = 2.256,
p = 0.010), along with increased rates of pneumonia (OR = 2.333,
p = 0.022) and acute renal insufficiency (OR = 2.125,
p = 0.046) at 3 months. Conversely, wrist stiffness was significantly lower in the methylprednisolone group at 1 week (OR = 0.471,
p = 0.046), 2 weeks (OR = 0.564,
p = 0.029), 1 month (OR = 0.653,
p = 0.045), and 3 months (OR = 0.722,
p = 0.049).
Conclusion: Postoperative methylprednisolone use after DRF ORIF is associated with reduced opioid prescriptions by 3 months, supporting its potential role in opioid stewardship. However, increased early complications warrant selective use with close monitoring to mitigate risks.
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