The Synergistic Effect of Preoperative Opioid Use and Many Associated Preoperative Predictors of Poor Outcome in the Trauma Patient Population

Abstract Objective : The 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. Design Retrospective Case Control Study Setting Academic Level-1 Trauma Center Patients/Participants Patients with long bone, lower extremity fractures requiring operative fixation Intervention N/A Main Outcome Measures Postoperative hospital admissions, emergency room (ER) visits, and reoperations. Results : 399 patients (opioid naive [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 Conclusions : Our 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. Level of Evidence Prognostic Level-III