Opioid Consumption after Foot and Ankle Surgery: The Influence of Payer Status

CATEGORY: Ankle, Hindfoot, Midfoot/Forefoot INTRODUCTION/PURPOSE: Opioid utilization after foot and ankle surgery has received more attention recently with several papers publishing guidelines on the number of opioids to prescribe following surgery. To our knowledge the patient populations that have been studied in all of these papers are all private payer mixes, with a low amount of indigent patients. Social factors often have a large influence over surgical outcomes and therefore we aimed to see if this held true for post-operative opioid utilization as well. In this study we investigated differences in opioid utilization among patients with either Medicaid, Medicare or commercial insurance. METHODS: All bony foot and ankle procedures performed by a single foot and ankle surgeon were reviewed between the dates of 7/1/2017 - 6/30/2018. Inclusion criteria were age over 18, did not have a history of chronic pain, and not incarcerated. Bony procedures included any osteotomy, fracture fixation, or arthrodesis. The number of narcotic prescriptions filled by the patient within 6 months following surgery was retrieved via the Texas Prescription Monitoring Program Database. Patients were also called and surveyed about their post-operative pain. The patients were then divided into 3 groups by payer status: commercial insurance including workman’s compensation, Medicaid including county insurance and self pay patients, and Medicare. RESULTS: 92 patients met inclusion criteria, 22 Medicare, 26 Medicaid, and 44 commercial. Medicaid patients filled more narcotic prescriptions than commercial and medicare patients (870 mg morphine equivalent vs 781 mg morphine equivalent for commercial and 649 mg morphine equivalent for medicare) however this difference was not statistically significant (Medicaid vs Medicare p = 0.07). Medicaid patients also needed a greater number of refills per patient (0.27 for Medicaid vs 0.20 and 0.09 for commercial and Medicare, p = 0.22) and had a larger number of telephone encounters for pain (p = 0.02) than the other payer types. CONCLUSION: Although not statistically significant, there was a trend toward greater opioid utilization within the Medicaid and county insured patient population.