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Substance use associated with Poor 90-day and 2-year postoperative outcomes after surgical fixation of distal radius fracture.
Paul J Pottanat, MD, Colin Zieminski, MD, Dane N Daley, MD; Charles A Daly, MD
Medical University of South Carolina, Charleston, SC
Introduction: Substance use is prevalent among patients with orthopedic injuries, including distal radius fractures (DRFs). While nicotine and cannabis use have been linked to poor outcomes after DRF fixation, data on other substances is limited. The purpose of this study is to assess the impact of alcohol, nicotine, cannabis, cocaine and methamphetamine use on 90-day and 2 year-outcomes following surgical fixation of DRFs.
Methods: The TriNetX database was queried for operatively treated DRFs. Preoperative substance use disorders including alcohol, nicotine, cannabis, cocaine, and methamphetamine were identified via ICD and CPT codes. Propensity matching controlled for comorbidities. Ninety-day outcomes included pain, opioid use, readmission, ED services, OT utilization, infection surgery, wound dehiscence, superficial SSI, deep SSI, DVT, sepsis, PE, UTI, stroke, MI, AKI, nerve injury, vessel injury, and mortality. Two-year outcomes included nonunion, malunion, malunion/nonunion revision surgery, tendon injuries, tendon injuries surgery, carpal tunnel syndrome, carpal tunnel release, complex regional pain syndrome, stiffness, manipulation, removal of hardware, all cause reoperation, and mortality.
Results: All substances were associated with increased 90-day medical complications including pain, opioids, PE, UTI, MI, and AKI. Healthcare utilization increased with higher readmission and ED visits but decreased OT participation. At two years, nicotine use was associated with the increased nonunion, nonunion/malunion requiring revision, tendon injury. All substances were associated with increased 2-year mortality.
Conclusion: Substance use correlates with higher short and long-term complications and increased healthcare utilization following DRF fixation. Surgeons should consider counseling patients on these patients on these risks, which may also influence decisions between surgical and nonoperative management.
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