The effect of alcohol use disorder on postoperative outcomes and recovery after femoral shaft fracture repair

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Background: The influence of alcohol use disorder (AUD) on outcomes following orthopaedic trauma remains poorly defined. This study evaluated postoperative surgical, medical, and psychiatric outcomes in patients undergoing femoral shaft fracture repair with and without AUD. Methods: The multi-institutional, national database was queried to identify adults undergoing femoral shaft fracture repair with or without a preexisting diagnosis of AUD. Rates of surgical and medical complications, new-onset psychiatric illness, and healthcare utilization were evaluated at 90 days and one year postoperatively. 1:1 propensity score matching was performed to control for demographic and comorbidity differences. Results: After matching, 2073 AUD patients were compared with 2073 controls. At 90 days, the AUD cohort had greater rates of new-onset depression with comparable rates of surgical complications. At one year, the AUD cohort demonstrated greater rates of all psychiatric illnesses including depression, anxiety, stress disorder, and opioid abuse and exhibited greater rates of hardware complications, and unplanned intubations. The AUD cohort demonstrated greater rates of prolonged opioid use and emergency department visits at both 90 days and one year. There was no difference in infection risk, nonunion, reoperation, thromboembolism, or readmission at either time point. Conclusions: Adults with AUD are at increased risk for hardware complications, prolonged opioid use, and new-onset psychiatric illness after femoral fracture repair. These findings support the integration of structured AUD screening, mental health assessment, and dedicated pain management pathways into the standard postoperative care protocol for femoral fracture patients. Level of evidence: Level III, Therapeutic/Care Management.

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