Perioperative opioid related disorders on outcomes following lower extremity fracture fixation: Comparative analysis from a multicenter national database

Background Opioid use can be common in patients who require surgical fixation of lower extremity fractures. While common, these medications place patients at risk for developing opioid-related disorders (OD) which can in turn affect bony healing and propagate endocrinopathies. This study aims to investigate the impact of perioperative opioid-related disorders on short- and long-term outcomes following open reduction and internal fixation (ORIF) of lower extremity fractures. Methods This retrospective study utilized the multicenter database TriNetX to identify patients who underwent ORIF of the lower extremity between 2003–2023 and had a minimum of 2 years follow up. The exposure of interest was the diagnosis of OD within 3 months prior to and following surgery stratifying them into two cohorts: OD cohort and control. 3986 patients were identified in the OD cohort and 211,560 patients in the control cohort. 1:1 Propensity score matching was applied for cohorts based on demographics, BMI and comorbidities resulting in 3970 patients in each cohort. Outcomes were assessed at 90 days and 2 years postoperatively. Statistical analyses calculated risk ratios (RR), confidence intervals (CI) and p-values. Results Within 90 days, patients with OD had increased rates of pulmonary embolism (RR: 1.74, p = 0.023), deep vein thrombosis (RR: 1.47, p = 0.018), transfusion (RR: 2.27, p < 0.001), wound complications (RR: 2.18, p < 0.001), and postoperative anemia (RR: 1.94, p < 0.001). At 2 years, they had higher rates of nonunion (RR: 1.4, p = 0.004), revisions/repairs (RR: 1.59, p < 0.001), implant-related infection (RR: 2.24, p < 0.001) and amputation (RR: 1.97, p = 0.001). Conclusion Perioperative opioid related disorders are associated with greater thromboembolic events, postoperative bleeding, and greater postoperative complications such as nonunion, wound complications, amputations and revisions. Further studies are needed to understand pathophysiologic and psychosocial effects of opioid disorders on fracture and wound healing. Level of evidence Level III, Retrospective Cohort.