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

Chronic opioid use has been linked to adverse surgical outcomes, yet its impact on ankle fracture surgery remains underexplored. This study evaluates the association between preoperative opioid use and postoperative health care utilization in patients undergoing surgical fixation for an isolated ankle fracture.

A retrospective cohort study was conducted at a level 1 trauma center over a 2-year period. Patients who underwent surgical fixation for an isolated ankle fracture were identified using Current Procedural Terminology (CPT) codes. Those with concurrent orthopaedic injuries or insufficient follow-up data were excluded. Patients were categorized as long-term opioid users (>3 months of opioid use) or opioid-naïve. Electronic medical records were reviewed to obtain data on patient demographics, comorbidities, injury characteristics, length of stay, opioid prescriptions, and 90-day postoperative outcomes, including emergency department (ED) visits, readmissions, and reoperations. Bivariate and multivariate analyses were used to assess the impact of opioid use on postoperative complications and health care utilization.

Of the 303 patients analyzed, 40 (13.2%) were long-term opioid users. Compared with opioid-naïve patients, opioid users had significantly longer hospital stays (5.3 ± 6.1 vs 2.6 ± 2.9 days, P < .001) and higher rates of 90-day ED visits (0.55 ± 1.11 vs 0.24 ± 0.61, P = .010), unplanned readmissions (0.33 ± 0.69 vs 0.076 ± 0.33, P < .001), and unplanned reoperations (0.18 ± 0.59 vs 0.05 ± 0.26, P = .026). Pain-related complaints were the most common reason for postoperative ED visits among opioid users. Logistic regression identified psychiatric history and hospital length of stay as independent predictors of increased readmissions, and hospital length of stay an independent predictor of postoperative ED visits. Opioid use alone was not predictive of readmissions or ED visits.

Preoperative opioid use is linked to longer hospital stays and increased postoperative health care utilization on unadjusted analyses. In multivariable models, psychiatric history and hospital length of stay, rather than opioid use alone, were independent predictors of readmissions and ED visits, suggesting that addressing psychiatric comorbidities and optimizing pain management strategies may improve outcomes in this patient population.

Level III, retrospective cohort study.