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Does the type of lower extremity fracture affect long-term opioid usage? A meta-analysis

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

 Patients recovering from musculoskeletal trauma have a heightened risk of opioid dependence and misuse, as these medications are typically required for pain management. The purpose of this meta-analysis was to examine the association between fracture type and chronic opioid use following fracture fixation in patients who sustain lower extremity trauma.

Materials and Methods

A meta-analysis was performed using PubMed and Web of Science to identify articles reporting chronic opioid use in patients recovering from surgery for lower extremity fractures. 732 articles were identified using keyword and MeSH search functions, and 9 met selection criteria. Studies were included in the final analysis if they reported the number of patients who remained on opioids 6 months after surgery for a specific lower extremity fracture (chronic usage). Logistic regressions and descriptive analyses were performed to determine the rate of chronic opioid use within each fracture type and if age, year, country of origin of study, or pre-admission opioid use influenced chronic opioid use following surgery.

Results

Bicondylar and unicondylar tibial-plateau fractures had the largest percentage of patients that become chronic opioid users (29.7–35.2%), followed by hip (27.8%), ankle (19.7%), femoral-shaft (18.5%), pilon (17.2%), tibial-shaft (13.8%), and simple ankle fractures (2.8–4.7%).Most opioid-naive samples had significantly lower rates of chronic opioid use after surgery (2–9%, 95% CI) when compared to samples that allowed pre-admission opioid use (13–50%, 95% CI). There were no significant associations between post-operative chronic opioid use and age, year, or country of origin of study.

Conclusions

 Patients with lower extremity fractures have substantial risk of becoming chronic opioid users. Even the lowest rates of chronic opioid use identified in this meta-analysis are higher than those in the general population. It is important that orthopedic surgeons tailor pain-management protocols to decrease opioid usage after lower extremity trauma.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA

    Alexandra G. Otwell, Jeffrey B. Stambough, Steven M. Cherney & Simon C. Mears

  2. Department of Academic Affairs, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA

    Lindsay Blake

  3. Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA

    Eric R. Siegel

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Correspondence to Simon C. Mears.

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Conflict of interest

Authors Otwell, Blake, Cherney and Siegel declare that they have no financial interests. Author Stambough declares relationships with the American Association of Hip and Knee Surgeons as a Board Member, American Joint Replacement Registry (AJRR) as a Board Member, Journal of Arthroplasty as an Editorial Board Member, Signature Orthopaedics as receiving IP royalties and Smith & Nephew as a Paid consultant. Author Mears declares relationships with Delta Ortho LLC as having Stock Options, Fragility Fracture Network as a Board or committee member, Journal of the American Geriatrics Society as an Editorial or governing board member, and SAGE as an Editorial or governing board member.

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Otwell, A.G., Stambough, J.B., Cherney, S.M. et al. Does the type of lower extremity fracture affect long-term opioid usage? A meta-analysis. Arch Orthop Trauma Surg 144, 1221–1231 (2024). https://doi.org/10.1007/s00402-023-05174-5

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  • DOI: https://doi.org/10.1007/s00402-023-05174-5

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