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Preoperative Opioid Use is Associated with Increased Complications After Distal Radius Internal Fixation: A Propensity-Matched Analysis
Matthew Q. Dao, BS
1, Patricia Fuentes, BS
2, Daniel Cho, BS
1, Arman Chowdhury, BS
1, Paul Won, MD
3, Rebecca Suydam, MD
4, Rami Dibbs, MD
5; BaiJing Qin, MD
5(1)John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, (2)Herbert Wertheim College of Medicine, Florida International University, Miami, FL, (3)Division of Plastic Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, (4)Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, (5)Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX
Introduction: Opioid use prior to surgery has been linked to adverse outcomes in various orthopedic procedures, yet there is limited literature detailing its impact on wrist fracture management. As open reduction and internal fixation (ORIF) is often the treatment of choice for distal radius fractures, distinguishing the risk profile that is associated with recent opioid exposure will improve perioperative planning and minimize complications.
Methods: Using the TriNetX US Collaborative Network, a retrospective review identified adult patients who underwent distal radius ORIF. Two cohorts were formed based on the presence or absence of opioid prescriptions (oxycodone, hydrocodone, morphine, tramadol, or codeine) within 14 days prior to operative treatment. Propensity score matching (1:1) was performed based on demographics (age, sex, race, ethnicity, BMI) and comorbidities (diabetes, hypertension, cerebrovascular disease, nicotine dependence, alcohol-related disorders, obesity, chronic kidney disease, liver disease, congestive heart failure, depression, anxiety, and hypothyroidism). Thirty-day postoperative complications and 1-year outcomes were compared between matched cohorts using risk ratios (RR) and 95% confidence intervals (CI), with significance set at p < 0.05.
Results: A total of 68,368 matched patients (34,184 per cohort) were analyzed. Within 30 days, the opioid group demonstrated significantly higher risks of skin and soft tissue infection (RR 1.36, p = 0.013), wound disruption (RR 1.58, p = 0.015), pulmonary embolism (RR 1.80, p = 0.019), postoperative gastrointestinal symptoms including nausea, vomiting, and diarrhea (RR 1.46, p = 0.001), and wrist pain (RR 1.32, p < 0.0001). At 1 year after surgery, the opioid group had increased rates of wrist stiffness (RR 1.47, p < 0.0001), reoperation (RR 1.69, p = 0.002), mechanical complications of fixation device (RR 1.38, p < 0.0001), and opioid use disorder (RR 1.63, p < 0.0001).
Conclusion: Preoperative opioid use within 2 weeks prior to distal radius ORIF is independently associated with higher rates of both early surgical complications and late functional or mechanical failures. Surgeons are encouraged to implement routine screening to reduce opioid-associated risks for patients undergoing operative treatment of distal radius fractures.
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