PURPOSE: Gabapentinoids are increasingly incorporated into multimodal analgesia after orthopaedic surgery, yet their impact on outcomes following fracture fixation remains unclear. This study evaluated the association between early postoperative gabapentinoid-opioid co-prescription and clinical outcomes after operative fixation of closed long bone fractures.
METHODS: Using TriNetX, we identified opioid-naïve and gabapentinoid-naïve adults undergoing intramedullary or plate-and-screw fixation of isolated closed diaphyseal tibia, humerus, or femur fractures. Patients prescribed gabapentin or pregabalin and opioids within three days after surgery were compared with patients receiving opioids alone. Propensity score matching (1:1) incorporated demographics, medical comorbidities, fracture location, fixation method, mental health disorders, and substance use disorders. Primary outcomes were prolonged (30-90 days) and chronic (90-180 days) postoperative opioid use. Secondary outcomes included 30-day emergency department (ED) visits and readmissions, and 1-year nonunion and reoperation.
RESULTS: After matching, each cohort consisted of approximately 2000 patients (range, 1946-2012). Gabapentinoid-opioid therapy was associated with higher rates of prolonged (21.0% vs 16.1%; RR 1.31; p < 0.001) and chronic (9.8% vs 7.4%; RR 1.33; p = 0.007) postoperative opioid use. Gabapentinoid-opioid therapy was associated with fewer 30-day ED visits (25.1% vs 42.5%; RR 0.59; p < 0.001), while 30-day readmission rates were similar between cohorts (p = 0.174). One-year rates of nonunion (4.3% vs 1.9%; RR 2.21; p < 0.001) and reoperation (7.1% vs 4.2%; RR 1.68; p < 0.001) were significantly higher among patients receiving gabapentinoid-opioid therapy. In a sensitivity analysis that defined the opioid-only cohort based on the absence of gabapentinoid prescriptions during the first 3 postoperative days, rather than the 1-year postoperative medication window used in the primary analysis, the associations with prolonged and chronic opioid use and reoperation were no longer statistically significant, whereas the association with nonunion remained significant (RR 1.62; p = 0.001).
CONCLUSION: Gabapentinoid-opioid therapy was associated with fewer ED visits and higher rates of prolonged and chronic opioid use, nonunion, and reoperation; in sensitivity analysis, ED visits and nonunion remained significant, whereas opioid use and reoperation did not. These findings suggest that potential short-term analgesic benefits may be offset by adverse long-term outcomes, warranting caution and further study of gabapentinoid-opioid prescribing for acute perioperative fracture pain.
Read the article: PubMed · Publisher (DOI)