Impact of Perioperative Opioid Prescriptions on Early and Late Complications After Rhinoplasty: A Propensity-Matched Study

BACKGROUND: Rhinoplasty is one of the most commonly performed facial plastic surgery procedures. Postoperative pain management frequently includes opioid prescriptions, although 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 rhinoplasty procedures. METHODS: A retrospective cohort study using the TriNetX Research Network identified patients undergoing rhinoplasty 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 419,449 rhinoplasty patients were identified, including 312,053 with perioperative opioid exposure and 107,396 controls. After propensity score matching, 85,201 patients remained in each cohort. During the early postoperative period, opioid exposure was associated with higher rates of overall complications (RR 2.11, 95% CI 1.94-2.29, P<0.0001), surgical site complications (RR 1.60, P<0.0001), infection (RR 1.82, P<0.0001), wound disruption (RR 1.53, P=0.0008), emergency department visits or readmissions (RR 2.23, P<0.0001), and mortality (RR 2.08, P<0.0001). During late follow-up, opioid exposure remained associated with higher rates of surgical site complications (RR 1.14, P=0.0049), infection (RR 1.48, P=0.0003), and wound disruption (RR 1.36, P=0.0044). CONCLUSIONS: Perioperative opioid prescriptions were associated with increased postoperative complications following rhinoplasty. These findings support continued efforts to optimize opioid-sparing analgesic strategies in rhinoplasty-related procedures.