Chronic Preoperative Opioid Use Is Associated With Increased Health Care Utilization Following Ankle Fracture Surgery

Area of Science:

• Orthopaedic Surgery
• Pain Management
• Health Services Research

Background:

• Chronic opioid use is associated with adverse surgical outcomes.
• The impact of preoperative opioid use on ankle fracture surgery outcomes is not well understood.

Purpose of the Study:

• To evaluate the association between preoperative opioid use and postoperative healthcare utilization in patients undergoing surgical fixation for isolated ankle fractures.

Main Methods:

• Retrospective cohort study at a level 1 trauma center.
• Identified patients undergoing ankle fracture fixation; categorized into long-term opioid users (>3 months) and opioid-naïve.
• Analyzed 90-day postoperative outcomes including ED visits, readmissions, and reoperations using bivariate and multivariate analyses.

Main Results:

• Long-term opioid users (13.2%) experienced significantly longer hospital stays (5.3 vs 2.6 days).
• Opioid users had higher rates of 90-day ED visits (0.55 vs 0.24), readmissions (0.33 vs 0.076), and reoperations (0.18 vs 0.05).
• Pain-related complaints were the primary reason for ED visits in opioid users.

Conclusions:

• Unadjusted analyses show preoperative opioid use linked to longer stays and increased healthcare utilization.
• Multivariable models identified psychiatric history and hospital length of stay as independent predictors of readmissions and ED visits, not opioid use alone.
• Optimizing pain management and addressing psychiatric comorbidities may improve outcomes.