Impact of Preexisting Substance Use Disorders on Prolonged Opioid Use and Postoperative Complications After Burns

Previous studies have linked preexisting substance use disorders (SUDs) to adverse postoperative outcomes in burn patients, yet their impact on opioid use remains unclear. This retrospective cohort study compares the effects of various substances on opioid use after burns and aims to analyze the risks and whether they differ among substances. The TriNetX database was queried for burn patients aged 18 years and older with preexisting alcohol, cannabis, or tobacco use disorders, who were placed in their respective cohorts. These patients were matched to a nonsubstance use disorder cohort using propensity score matching based on demographics, mental health, pain syndromes, and burn severity. The measured outcomes assessed were opioid use, wound infection, wound disruption, and postprocedural pain. Risk ratios and 95% confidence intervals were calculated at 3 months and 12 months postburn. After matching, patients with preexisting SUDs had significantly higher risk ratios for prolonged opioid use, wound infections, and wound healing disruptions at both 3 and 12 months compared to matched patient control cohorts. Additionally, all patient cohorts also exhibited increased risk of postprocedural pain. Burn patients with preexisting SUDs face a significantly higher risk of prolonged opioid use and postoperative complications at both 3- and 12-month postburn injury. The alcohol cohort patients were associated with the greatest increase in opioid use and postoperative complications, while the tobacco patient cohort presented with the highest wound disruption rates at 3- and 12-months postburn.