Opioid use in impending versus pathologic proximal femur fractures.

Abstract

e24061 Background: Pathologic and impending fractures commonly occur in the proximal femur, and patients may be prescribed opioids prior to surgery and often require opioids for postoperative pain relief. This study compared postoperative opiate usage and ambulatory functional status in patients with impending versus pathologic fractures in the proximal femur. Methods: This was a retrospective review of patients using opioids postoperatively who underwent internal fixation for a pathologic or impending fracture between 2016 and 2022. Preoperative and postoperative opioid usage as well as ambulation status and risk factors at three and six months associated with postoperative opioid use were recorded. Results: Twenty-four pathologic fractures and twenty-three impending fractures were included. Preoperative opioid daily morphine milligram equivalent (MME) was significantly higher in the pathologic fracture group (p = 0.021), but there were no significant differences at three or six months. In the impending fracture group, daily MME at three months was significantly higher than preoperative daily MME (p = 0.018) but returned to preoperative levels at six months. There was statistically significant improvement in ambulation status in the combined cohort (p = 0.008) and impending fracture cohort (p = 0.016) at 6 months. Conclusions: Although patients did not experience a significant postoperative change in opioid use, patients with pathologic fractures notably required higher opioid dosages and there was overall improvement in function following fixation. Future studies should examine postoperative opioid use with careful consideration of concurrent pain management pain therapies and tumor characteristics.[Table: see text]