Perioperative Opioid Exposure and Postoperative Complications Following Facial Fracture Repair: A Propensity-Matched Analysis of 71,738 Patients

PURPOSE:
Opioids are commonly prescribed after facial fracture repair, but their impact on recovery remains uncertain in contemporary practice today. We evaluated the association between perioperative opioid prescriptions and postoperative complications.
METHODS:
Using the TriNetX Research Network (2005-2025), we identified patients undergoing facial fracture repair, excluding those with opioid use disorder or cancer. Cohorts were defined by documented perioperative opioid prescriptions and balanced 1:1 by propensity scores for demographics and comorbidities. Outcomes were assessed at 1-30 days and 31-365 days.
RESULTS:After matching, 71,738 patients were included (35,869 per cohort). Opioid exposure was associated with higher early complications, including infection (OR 3.00, 95% CI 2.38-3.78), wound disruption (OR 2.35, 1.90-2.92), surgical-site complications (OR 2.07, 1.83-2.35), and mortality (OR 1.70, 1.15-2.51). Elevated risks persisted long-term for infection (OR 2.05, 1.66-2.54), wound disruption (OR 2.10, 1.70-2.59), thrombotic events (OR 1.38, 1.06-1.80), and surgical-site complications (OR 1.37, 1.26-1.50).
CONCLUSION:
Perioperative opioid exposure in facial fracture repair is associated with increased risks of infection, wound breakdown, thrombosis, and mortality, extending up to one year. These observational findings support cautious prescribing and multimodal, opioid-sparing analgesia. Residual confounding may reflect patient comorbidity profiles; prospective studies, including randomized trials, are needed to determine causality and refine stewardship.