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0% of preoperative narcotic-free patients, 35.2% opioid users (relative risk [RR] 5.83 [5.63-6.03]), 9.2% tramadol users (RR 1.52 [1.40-1.63]), and 29.5% opioid or tramadol users (RR 4.88 [4.72-5.05]). Opioid or tramadol prescriptions were filled by 7.7% of preoperative narcotic-free patients, 37.3% opioid users (RR 4.84 [4.70-4.99]), 26.2% tramadol users (RR 3.40 [3.26-3.57]), and 35.7% opioid or tramadol users (RR 4.64 [4.50-4.78]) at 12 months. CONCLUSION Patients taking tramadol preoperatively were found to be at lower risk for prol