Substance Use Associated With Poor 90-Day and 2-Year Postoperative Outcomes After Surgical Fixation of Distal Radius Fracture.

Abstract

Substance use is prevalent among patients with orthopedic injuries, including distal radius fractures (DRFs). While nicotine and cannabis use have been linked to poor outcomes after distal radius fracture fixation, data on other substances is limited. The purpose of this study is to assess the impact of alcohol, nicotine, cannabis, cocaine, and methamphetamine use on 90-day and 2-year outcomes following surgical fixation of DRFs. The TriNetX database was queried for operatively treated DRFs. Preoperative substance use disorders including alcohol, nicotine, cannabis, cocaine, and methamphetamine were identified via International Class of Diseases and Current Procedural Terminology (CPT) codes. Propensity matching controlled for comorbidities. Ninety-day outcomes included pain, opioid use, readmission, emergency department (ED) services, operation theatre (OT) utilization, infection surgery, wound dehiscence, superficial surgical site infection (SSI), deep SSI, deep vein thrombosis, sepsis, pulmonary embolism (PE), urinary tract infection (UTI), stroke, myocardial infarction (MI), acute kidney injury (AKI), nerve injury, vessel injury, and mortality. Two-year outcomes included nonunion, malunion, malunion/nonunion revision surgery, tendon injuries, tendon injuries surgery, carpal tunnel syndrome, carpal tunnel release, complex regional pain syndrome, stiffness, manipulation, removal of hardware, all-cause reoperation, and mortality. All substances were associated with increased 90-day medical complications including pain, opioids, PE, UTI, MI, and AKI. Healthcare utilization increased with higher readmission and ED visits but decreased OT participation. At 2 years, nicotine use was associated with the increased nonunion, nonunion/malunion requiring revision, and tendon injury. All substances were associated with increased 2-year mortality. Substance use correlates with higher short- and long-term complications and increased healthcare utilization following distal radius fracture fixation. Surgeons should consider counseling patients on these risks, which may also influence decisions between surgical and nonoperative management.