The Impact of Methylprednisolone on Opioid Use After Open Mandible Fracture Repair: A Propensity Score-Matched Analysis

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BACKGROUND: Postoperative pain following open mandible fracture repair is common and often necessitates opioid analgesia, which carries the risk of opioid use disorder. Methylprednisolone, a potent perioperative antiinflammatory agent, may reduce pain and subsequent opioid requirements. This study investigates whether perioperative methylprednisolone use decreases opioid consumption in the postoperative period after open mandible fracture repair. METHODS: The TriNetX database was queried to identify patients who underwent open repair of mandibular fractures. Patients were stratified into an exposed cohort (who received methylprednisolone) and a control cohort (who received no methylprednisolone). Propensity score matching was performed to adjust for opioid use risk factors. The primary outcome was opioid use, with secondary outcomes including wound complications (external and internal dehiscence) and infectious complications (surgical site infection, pneumonia, urinary tract infection, and intravenous catheter infection). Risk estimates and Kaplan-Meier survival analyses were performed at 7 and 30 days. RESULTS: After matching, 1967 patients were included in each cohort. At 7 days following surgery, patients who received methylprednisolone had a significantly decreased risk of opioid use (risk ratio [RR] 0.63, P <0.001) compared with the control cohort. Similarly, at 30 days following surgery, the exposed cohort had a significantly decreased risk of opioid use (RR 0.76, P <0.001) compared with the control cohort. No significant differences were observed in wound or infectious complications. CONCLUSION: In this large retrospective study, perioperative methylprednisolone use during open mandible fracture repair was associated with reduced opioid requirements, without increasing wound or infectious complications.

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