Opioid Use Disorder in Patients Undergoing Major Lower Extremity Amputation: Prevalence and Outcomes

Patients with a history of Opioid Use Disorder (OUD) have higher postoperative complication rates and mortality in many settings. Yet, it remains poorly understood how the opioid epidemic has affected patients undergoing major lower extremity amputation (LEA) and whether outcomes differ by OUD status.

We conducted a retrospective chart review of all 689 patients who underwent major LEA at a large tertiary referral center from 2015 to 2021. This study assessed patient characteristics and long-term postoperative outcomes for patients with preoperative OUD.

133 (19.3%) patients had a lifetime history of preoperative OUD. Preoperative OUD was associated with key characteristics, comorbidities, and outcome measures. OUD was significantly associated with younger age (P < .001), black race (P = .026), single relationship status (P < .001), BMI <30 (P = .024), no primary care provider (P = .004), and Medicaid insurance (P < .001). Comorbidities significantly associated with OUD include current smoking (P < .001), Human Immunodeficiency Virus (HIV; P = .003), and history of osteomyelitis (P < .001). Preoperative OUD independently predicted lower rates of 30-60-day readmission (odds ratio [OR] .54, P = .018) and 1-12-month reamputation (OR .41, P = .006). There was no significant difference in long-term mortality and follow-up.

This study demonstrates the prevalence of OUD in patients undergoing major LEA and reports associations and long-term outcomes. Our findings highlight the importance of recognizing OUD and raise questions about the mechanisms underlying its relation to rates of postoperative readmission and reamputation.