Time to Surgical Intervention for Ankle Fractures as a Factor in Perioperative and Prolonged Opioid Use

This study examined the association between time to surgery post-ankle fracture and perioperative, subacute, and prolonged opioid use.

This was a retrospective cohort study that used the Merative MarketScan Commercial Claims and Encounters Database. It included patients aged 18 to 64 with an ankle fracture between April 1, 2016, and June 30, 2021, who underwent open reduction and internal fixation within 21 days. Time to surgery was categorized as 0 to 3 days, 4 to 7 days, and 8 to 21 days. Multivariable logistic regression models assessed associations between time to surgery and perioperative (fracture through 7 days after surgery), subacute (31 to 90 days), and prolonged (91 to 180 days) opioid use, adjusting for relevant covariates.

The cohort included 20,642 patients (61.7% female, median age 48); 47.5% had surgery 0 to 3 days after fracture, 25.1% 4 to 7 days, and 27.4% 8 to 21 days. Later surgery (versus 0 to 3 days) was associated with increased perioperative opioid use (4 to 7 days: odds ratio [OR] 2.39, 95% CI 2.13-2.69, P<0.001; 8 to 21 days: OR 2.53, 95% CI 2.25-2.84, P<0.001). Having surgery at 8 to 21 (versus 0 to 3) days was significantly associated with increased prolonged use in those who filled a perioperative opioid prescription after adjusting for perioperative medications (OR 1.20, 95% CI 1.03-1.42, P=0.02).

The study highlights the role of surgical timing in opioid use after ankle fractures. Surgery beyond 7 days after fracture was associated with increased perioperative opioid use and slightly elevated prolonged use in those who filled perioperative opioids. Orthopedic surgeons should consider timely interventions to mitigate prolonged opioid use, thus promoting safer postoperative care in ankle fracture patients.