Perioperative NSAID use and postoperative outcomes after distal radius fracture surgery: a propensity-matched cohort study

Abstract Purpose Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain management following distal radius fracture (DRF) surgery, yet their effects on postoperative complications remain unclear. This study evaluated the association between perioperative prescriptive NSAID use and surgical and medical complications following DRF surgery. Methods A retrospective cohort study using the TriNetX database identified adult patients who underwent DRF surgery between 2012 and 2024. Patients were categorized based on NSAID prescription within 1 day before to 1 month after surgery. Propensity score matching controlled for demographic variables. Primary outcome was 1-year surgical complications (malunion/nonunion surgery, postoperative infection, and revision surgery). Secondary outcomes included 90-day medical complications (myocardial infarction, gastrointestinal bleeding, acute kidney injury, emergency department visits, and readmission). Statistical analyses included Kaplan-Meier survival analysis and Cox proportional hazards regression. Results Among 76,913 patients identified, 30,760 matched pairs were analyzed. The primary outcome of malunion/nonunion surgery at 1 year showed no significant difference after matching. At 1 year, NSAID prescription patients had significantly higher rates of postoperative infection and revision surgery. Within 90 days, NSAID prescription patients demonstrated higher emergency department visit rates but no significant differences in myocardial infarction, gastrointestinal bleeding, acute kidney injury, or readmission. Conclusions Despite statistically significant increases in postoperative infections, revision surgery, and emergency department visits, absolute risk differences were modest (less than 1% for all outcomes). No significant difference was observed in the primary outcome of malunion/nonunion surgery, and this null finding persisted across sensitivity analyses restricted to nonselective NSAIDs and to a 1-week exposure window. Given the small absolute risk differences observed and the effectiveness of NSAIDs for pain control, these findings suggest that perioperative NSAID use is not associated with a clinically meaningful increase in fracture nonunion, though the modest increases in infection and revision surgery warrant individualized risk-benefit discussion, particularly in patients with additional risk factors for these complications. Level of evidence III.