Opioid Consumption Following Foot and Ankle Surgery: A Systematic Review

Abstract

Category: Other; Hindfoot Introduction/Purpose: The opioid epidemic in the United States has gained significant attention over the past few years. Subsequently, there have been several publications characterizing postoperative opioid consumption in patients who underwent foot and ankle surgery. Our goal was to systematically review the literature to identify trends in opioid consumption between procedures of the forefoot, midfoot, hindfoot and ankle and ultimately create finalized prescribing guidelines that treat patients’ pain adequately while limiting leftover pills. Methods: A systematic review was performed in concordance with the MOOSE guidelines. We included retrospective and prospective observational cohort studies that reported on mean opioid consumption following foot and ankle surgery, as well as unpublished data from our institution that fit the review’s parameters. We excluded studies that did not report this data or reported patients receiving alternative surgical techniques. The ROBINS-E tool was used to assess bias and the MINORS criteria was used to evaluate study quality. Results: Six studies met inclusion criteria from 395 identified articles. Reported data from 2,445 patients were analyzed for overall opioid consumption, region of surgery, and invasiveness of procedure. Five studies standardized opioids prescribed and consumed to a 5-milligram oxycodone "pill." Of the three studies reporting mean pill consumption by region of surgery, 16.1, 27.8, and 26.4 pills were consumed by forefoot, midfoot, and hindfoot patients, respectively. The largest mean and median pill consumption was observed in hindfoot patients (45.7 and 22, respectively). 4 of 5 studies found significantly higher opioid use in hindfoot and ankle patients, and 2 of 5 studies found significantly higher consumption among those undergoing bony versus soft-tissue procedures. Across all studies, patients used 45.7%-75.2% of their opioid prescriptions. Conclusion: In this systematic review, we identify literature reported mean number of recommended pills to be subscribed for each anatomical region, as prescriptions could be decreased by around half and still adequately control pain. This can be of significant aid in providing final guidelines to orthopedic surgeons to finalize prescription patterns in foot and ankle surgery based on the published literature.