• Shea M Comadoll, Boshen Liu, Eric Abbenhaus, John D King, Cale A Jacobs, Arun Aneja, Joseph R Hsu, and Paul E Matuszewski.
• University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, KY, United States.
• Injury. 2020 Apr 1; 51 (4): 919-923.

ObjectiveThe purpose of this study is to investigate if preoperative opioid use is associated with other predictors of poor outcome and the effect of these factors on complications. We hypothesized that preoperative opioid use (POU) is associated with increased rates of postoperative complications.DesignRetrospective case control study.SettingAcademic level-1 trauma center.Patients/ParticipantsPatients with long bone, lower extremity fractures requiring operative fixation.InterventionN/A.Main Outcome MeasuresPostoperative hospital admissions, emergency room (ER) visits, and reoperations.Results399 patients (opioid naïve [ON] 80.2%, Age 38, 95% CI 35.9-39.6) were reviewed. Patients who had POU were older (P = 0.004), had higher BMI (P = 0.03), proportion of females (P < 0.001), tobacco use (P < 0.001), proportion of American Society of Anesthesiologist (ASA) class ≥ 3 (P < 0.001), and rates of substance use disorder (SUD) (P < 0.001). POU was associated with prolonged opiate use at 6 months (60.8%), 1 year (43.0%), higher rates of postoperative readmissions (18.1%), ER visits (17.2%), reoperations (17.5%), and complications (Odds Ratio [OR]: 2.4, P < 0.01). The risk of complication increased synergistically with the addition of other predictors: less than a high school education (OR: 4.6, P = 0.001); ASA class ≥3 (OR: 5.6, P < 0.001). All three factors combined also increased risk of complication synergistically (OR: 9.1, P = 0.003).ConclusionsOur study demonstrates that many predictors of poor outcome frequently accompany POU. POU combined with many of these predictors synergistically increases the risk of complication. Outcomes-based payment models should reflect this expected rate of readmissions, ER visits and complications in this group. Patients with POU should be targeted with multi-disciplinary interventions aimed to modify these risk factors.Copyright © 2020. Published by Elsevier Ltd.

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