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Preoperative Opioid Use Increases Complications After Scaphoid Fracture Surgery: A Retrospective Cohort Analysis
Carolyn Henein, MS, Cameron Bowers, BS, Joshua Wang, MS, Philong Nguyen, BS; John Faillace, MD
University of Texas Medical Branch, Galveston, TX
Background: Preoperative opioid use is prevalent among patients undergoing scaphoid fracture repairs and is associated with worse postoperative outcomes. This study aims to evaluate the impact of preoperative opioid use on clinical outcomes of scaphoid fracture repair surgeries.
Methods: This retrospective cohort study utilized the TriNetX Research Network to identify patients who underwent scaphoid fracture surgery (open, percutaneous, or nonunion) between January 1, 2000, and January 1, 2023. Patients were stratified based on the use of opioids 1 year to 1 day prior to surgery. Propensity score matching was performed in a 1:1 ratio, adjusting for demographics and comorbidities. Short-term outcomes were evaluated at 90-day follow-up and long-term outcomes at 2-year follow-up. Significant outcomes (
p<0.05) with risk ratio (RR) and 95% confidence interval (95% CI) were reported.
Results: At 90-day follow-up (n=1,795), preoperative opioid use patients were associated with higher risk of postoperative infection (RR: 1.933, 95% CI: (1.04,3.594)) and paresthesia (RR: 1.68, 95% CI: (1.028,2.744)). At 2-year follow-up (n=1,847), preoperative opioid use patients experienced significantly higher rates of subsequent scaphoid fracture surgery (RR: 3.188, 95% CI: (1.825,5.569)), paresthesia (RR: 1.5, 95% CI: (1.121,2.007)), and pseudarthrosis (RR: 1.765, 95% CI: (0.977,3.188)).
Conclusion: Preoperative opioid use is associated with a higher risk of postoperative complications and future scaphoid fracture surgeries. Optimizing opioid management prior to surgery may improve surgical outcomes and reduce postoperative morbidity.
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