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Perioperative Opioid Exposure and Postoperative Complications Following Facial Fracture Repair: A Propensity-Matched
Aneeq S Chaudhry1, Anshumi Desai2, Sinan K Jabori2
1Division of Plastic and Reconstructive Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL.
Background:
Facial fracture repair is commonly performed following traumatic injury. Postoperative pain is frequently managed with opioid prescriptions. However, opioid exposure has been associated with impaired wound healing and increased postoperative complications in several surgical populations. This study aims to evaluate the association between perioperative opioid prescriptions and postoperative complications following facial fracture repair procedures.
Methods:
A retrospective cohort study using the TriNetX Research Network identified patients undergoing facial fracture repair between 2005 and 2025 using Current Procedural Terminology codes. Patients were stratified by documented opioid prescriptions within 2 weeks postoperatively. Individuals with prior opioid-related disorders or malignancy were excluded. Outcomes were assessed during early (1-30 d) and late (31-365 d) postoperative intervals.
Results:
A total of 207,750 patients undergoing facial fracture repair were identified. This included 162,449 patients with perioperative opioid exposure and 45,301 controls. After propensity score matching, 35,869 patients remained in each cohort. During the early postoperative period, opioid exposure was associated with higher rates of overall complications (OR: 1.75, P < 0.0001), surgical site complications (OR: 2.07, P < 0.0001), infection (OR: 3.00, P < 0.0001), wound disruption (OR: 2.35, P < 0.0001), and emergency department visits or readmissions (OR: 1.67, P < 0.0001). During late follow-up, opioid exposure remained associated with higher rates of surgical site complications (OR: 1.37, P < 0.0001), infection (OR: 2.05, P < 0.0001), and wound disruption (OR: 2.10, P < 0.0001).
Conclusions:
Perioperative opioid prescriptions were associated with increased postoperative complications following facial fracture repair. These findings support continued efforts to optimize opioid-sparing analgesic strategies in patients undergoing facial trauma reconstruction.
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