Abstract 
Objectives: The purpose of this study was to investigate if preoperative opioid use is associated with other predictors of poor outcomes and the effect of these factors on postoperative complications. We hypothesized that preoperative opioid use is associated with increased rates of postoperative complications.
Design: Retrospective Study 
Setting: Academic Level-1 Trauma Center 
Patients/Participants: Patients with traumatic lower extremity fractures requiring operative fixation at our Level-1 Trauma Center 
Intervention: History of preoperative opioid use and other social history 
Main Outcome Measures: Returns for further medical care including postoperative hospital admissions, emergency room (ER) visits, and reoperations.
Results: The final study cohort consisted of 399 patients (opioid naïve [ON] 80.2%,
Age 38, 95% CI 35.9-39.6). Patients who had preoperative opioid use (POU) were predominantly older (P=0.004) and had a higher BMI (P=0.03). The POU cohort also had a higher proportion of females (P<0.001), higher rates of tobacco use (P<0.001), higher proportion of American Society of Anesthesiologist (ASA) class ≥ 3 (P<0.001), and higher rates of history of substance abuse (HSA) (P<0.001). 71.8% of POU smoked tobacco or had a HSA, while 27.1% had both. The POU patient cohort had 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 increased rate of complications (Odds Ratio [OR]: 2.4, P<.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<.001). All three factors combined also increased the risk of complication synergistically (OR: 9.1, P=0.003). In combination preoperative smoking, POU, and increased BMI were predictive of postoperative ER visits (r2 = 0.14, P<0.001).
Conclusions: Our study demonstrates that many commonly known predictors of poor outcome (male gender, age, tobacco use, BMI, HSA, ASA ≥ 3) frequently accompany POU. POU combined with many of these predictors synergistically increases the risk of complication. Patients with POU should be targeted with multi-disciplinary interventions aimed to modify these risk factors to prevent complications and ultimately improve outcomes.

Orthopaedic Trauma Association