Prolonged Opioid Use and Associated Factors After Open Reduction and Internal Fixation of Tibial Shaft Fractures

Background: The aim of this retrospective cohort study was to determine the rate of prolonged opioid use and identify associated risk factors after perioperative opioid exposure for tibial shaft fracture surgery. Materials and Methods: We used the MarketScan Commercial Claims and Encoun- ters database (IBM) to identify patients 18 to 64 years old who filled a peri- operative opioid prescription after open reduction and internal fixation of a tibial shaft fracture from January 2016 to June 2020. Multivariable logistic regression identified factors (eg, demographics, comorbidities, medica- tions) associated with prolonged opioid use (ie, filling an opioid prescription 91 to 180 days postoperatively); adjusted odds ratios (ORs) and 95% CIs were reported. Results: The rate of prolonged opioid use was 10.5% (n=259/2475) in the full cohort and 6.1% (n=119/1958) in an opioid-naive subgroup. In the full cohort, factors significantly associated with increased odds of prolonged use included preoperative opioid use (OR, 4.76; 95% CI, 3.60-6.29; P <.001); perioperative oral morphine equivalents in the 4th (vs 1st) quartile (OR, 2.68; 95% CI, 1.75-4.09; P <.001); age (OR, 1.03; 95% CI, 1.02-1.04; P <.001); and alcohol or substance-related disorder (OR, 1.66; 95% CI, 1.15-2.40; P =.01). Patients in the Northeast and North Central (vs South) regions had decreased odds of prolonged use (OR, 0.61-0.69; P =.02-.04). When removing preoperative use, findings were similar in the opioid-naive subgroup. Conclusion: Prolonged opioid use is not uncom- mon in this orthopedic trauma population, with the strongest risk factor being preoperative opioid use. Nevertheless, shared risk factors exist be- tween the opioid-naive and opioid-tolerant subgroups that can guide clinical decision-making.