Opioid Use, Perioperative Risks, and Associated Postoperative Complications in Foot and Ankle Surgery

CATEGORY: Ankle, Midfoot/Forefoot, Opioid Use Research INTRODUCTION/PURPOSE: Within the United States, opioid abuse has become a national crisis. Twenty-nine percent of patients prescribed opioids misuse them with nearly 12% developing addiction. One previous study has shown that patients undergoing foot/ankle surgery were left with extra narcotic pain medications following surgery, many of whom would have preferred to dispose of them. Our purpose was to evaluate factors in foot and ankle surgery that are associated with increased risk of prolonged post-operative opioid pain medication usage and identify the risk of various post-operative complications that may be associated with pre-operative opioid usage. We hypothesize that pre-operative opioid use will place patients at an increased risk of post-operative usage. METHODS: The MarketScan commercial claims and encounters database, including approximately 39 million patients per year, was searched to identify patients who underwent foot/ankle surgery based on CPT code from 2005-2014. Preoperative comorbidities including DSM-V mental health disorders, chronic pain, chronic regional pain syndrome (CRPS), obesity, tobacco use, medications and diabetes were queried and documented. Patients who utilized opioids at least one month up to 3 months prior to surgery were identified. This timeframe was chosen to exclude patients who had been prescribed post-operative narcotic medications up to 1 months pre-operatively. We utilized odds ratios (OR), 95% Confidence Intervals (CI), and regression analysis to determine factors that are associated with prolonged post-operative opioid use at 3 time intervals. RESULTS: 112,893 patients underwent foot/ankle surgery. 11,523 (10.2%) patients utilized opioids 1-3months pre-operatively. Of those, 5,732 (5.0%) utilized opioids post-operatively at 6 weeks, 4,364 (3.8%) at 3 months, 3,475 (3.08%) at 6 months and 2,579 (2.2%) at 1 year. Pre-operative opioid use was associated with increased post-operative use (6-12weeks: OR 7.24, 95% CI 6.92- 7.58; 3-6months: OR 11.03, 95% CI 10.45-11.63; 6-12months: OR 14.1, 95% CI 13.3-15.1; >12months: OR 14.74, 95% CI 13.68-15.88). Tobacco use, chronic pain, DSM-V diagnosis and non-opioid analgesia yielded increased risk of post-operative opioid usage. Diagnosis of CRPS, obesity or diabetes did not have an increased risk. Pre-operative opioid use was associated with an increased risk of readmission, DVT, pulmonary embolism, I&D of surgical site, myocardial infarction, UTI and post-operative bleeding (Table 1). CONCLUSION: Our study found a number of factors that are associated with prolonged post-operative opioid usage which included pre-operative opioid use 1-3months before surgery, tobacco use, chronic pain, DSM-V diagnoses and pre-operative use of certain non-opioid medications. We also found patients with pre-operative opioid exposure to be at an increased risk of a number of significant post-operative complications, including an increased risk of readmission at 30 and 90 days. This data provides orthopaedic surgeons a number of variables to consider when determining post-operative analgesia strategies, and provides health systems, providers and payers information on complications associated with pre-operative opioid utilization.