Association Between Early Opioid Prescribing and New Persistent Use After Distal Radius Fracture: A Retrospective Cohort Study.

PURPOSE: Distal radius fractures (DRFs) are common orthopaedic injuries often requiring surgical intervention. While opioids are frequently prescribed for postoperative pain, concerns regarding new persistent opioid use have emerged, particularly in opioid-naïve patients. This study examines whether early postoperative opioid prescribing increases the risk of new persistent opioid use following DRF surgery.

METHODS

A retrospective cohort analysis was conducted using the TriNetX database. Opioid-naïve patients undergoing DRF surgery were stratified into opioid and no-opioid cohorts based on prescription within 30 days postoperatively. Propensity score matching was applied to adjust for confounding variables. The primary outcome was new persistent opioid use, while secondary outcomes included mortality, new mental health disorders, and persistent upper extremity pain from 90 days through one year postoperatively.

RESULTS

Early opioid prescription was associated with a significantly higher risk of new persistent opioid use (4.2% vs. 1.4%), an increased rate of persistent forearm, hand, or finger pain (1.0% vs. 0.6%), and a higher incidence of wrist pain (5.8% vs. 3.8%) (all p < 0.01). No significant differences in mortality or new mental health disorders were observed.

CONCLUSIONS

Early opioid prescribing following DRF surgery is significantly associated with new persistent opioid use and persistent upper extremity pain. These findings may highlight the need for judicious opioid use and alternative pain management strategies to reduce the risk of prolonged opioid utilization.

LEVEL OF EVIDENCE: Therapeutic, Level III.