Incidence and Predictive Factors for Prolonged Use of Opioid Medication After Foot and Ankle Surgery

Abstract

Category: Other Introduction/Purpose: The purpose of this study is to evaluate the incidence and factors predictive for patients’ needs for opioid pain medication longer than 2 weeks after orthopaedic foot/ankle surgery in a single surgeon’s practice at a tertiary care center. We hypothesize that the number of patients that require opioids for pain management after 2 weeks post-operatively is low, but certain patient factors may be predictive for those individuals that request these medications at this time period. Methods: This is a prospective study of patients that received orthopaedic foot/ankle surgery between August 2016 and November 2017 by a single surgeon. Inclusion criteria involved surgical patients lacking chronic use of opioids. Patients regularly taking opioids pre-operatively were excluded from this study. Patients’ charts were reviewed for their age, weight, and medical co-morbidities. The diagnosis and procedure(s) that each patient received was recorded. Postoperatively, all patients received 60 tablets of opioids for one to be taken every 6 hours as needed for pain within 2 weeks from surgery. Every patient’s postsurgical course was examined for those that asked for and received opioids after 2 weeks from surgery. This event was defined as prolonged post-operative use of opioids. Results: Of 285 opioid-naïve patients that enrolled in this study and received foot/ankle surgery, 35 (12.3%) asked for and received opioids after 2 weeks from surgery. Three of these 35 patients asked for and received opioids after 4 weeks from surgery. No patients asked for and received opioids after 4 weeks from surgery. Age and anatomical location of surgery were not significantly prognostic for a post-surgical wound complication (P>0.05). Those patients of female gender, morbid obesity, and psychiatric conditions such as anxiety and depression were significantly predictive of requesting opioids after 2 weeks from surgery (P<0.05). Those individuals that received revision foot and/or ankle surgery trended towards a higher likelihood of requesting opioids after 2 weeks from surgery (P<0.15). Conclusion: This study demonstrates that the number of patients that require prolonged post-operative use of opioid medicine after orthopaedic foot and/or ankle surgery is low. However, this research shows that female patients with certain medical conditions such as morbid obesity and psychiatric illness are significantly likely to request opioids after 2 weeks from surgery. This is highly important when providing patients with realistic expectations of pain from foot/ankle surgery and the effectiveness and duration of opioids that help treat such pain.