The Impact of Opioid Use on Postoperative Outcomes Following Talus Surgery: A Propensity Score-Matched Cohort Study

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Opioids are commonly prescribed for postoperative pain management, but their potential impact on surgical outcomes remains a critical area of investigation. Opioid use has been associated with altered immune function, impaired bone healing, and an increased risk of complications, which may influence recovery following orthopedic procedures. This study evaluates the effects of preoperative opioid use on postoperative outcomes in patients undergoing open reduction and internal fixation (ORIF) of talus fractures. By comparing 90-day and 2-year complication rates, including wound disruption, infection, thromboembolic events, and avascular necrosis, this study aims to determine whether opioid use adversely affects surgical recovery. Identifying these associations can help guide perioperative opioid prescribing practices and optimize patient outcomes following talus fracture surgery. Methods: This retrospective cohort study utilized TriNetX, a global federated research network, to analyze electronic health records from 97 healthcare organizations. Patients who underwent ORIF for talus fractures (CPT: 28445) were categorized into two cohorts: those with preoperative opioid use (n=3,242) and those without (n=1,934). After propensity score matching, 1,288 patients remained in each group for comparison. Outcomes assessed at 90 days and 2 years included wound disruption, infection, sepsis, deep vein thrombosis (DVT), pulmonary embolism (PE), complex regional pain syndrome (CRPS), mechanical complications, avascular necrosis, and readmission rates. Risk differences, risk ratios, and odds ratios were calculated to assess long-term complication-free survival. Statistical significance was defined as p< 0.05. This study aimed to provide insight into whether preoperative opioid use increases the risk of adverse postoperative outcomes in talus fracture surgery. Results: At 90 days postoperatively, opioid users had a higher incidence of wound disruption (2.6% vs. 2.1%, p=0.364) and infection (3.0% vs. 2.6%, p=0.473), though these differences were not statistically significant. At the 2 years, the risk for repair of surgery was significantly higher in the opioid cohort (Risk difference 2.6%; p < 0.001) with a risk ratio of 4 (95% CI: 2.075-7.710). The opioid group also demonstrated a higher, but not statistically significant, rate of mechanical complications (Risk difference 1.1%; p = 0.071) and avascular necrosis of the foot (Risk difference 0.6%; p = 0.224). These findings suggest a potential association between opioid use and wound-related complications but do not confirm a substantial increase in thromboembolic or long-term adverse events. Conclusion: Preoperative opioid use was not significantly associated with an increased risk of major postoperative complications following talus fracture surgery. However, a modest increase in wound-related complications was observed, warranting further investigation. While opioids remain an important component of perioperative pain management, clinicians should weigh their potential risks against benefits when prescribing preoperatively. Future studies with larger sample sizes and prospective designs may better elucidate the relationship between opioid use and surgical outcomes. Optimizing pain management strategies while minimizing opioid exposure may contribute to improved recovery and reduced postoperative complications in patients undergoing talus fracture surgery.