Assessing the Influence of Pain and Resiliency Scores on Post-Operative Outcomes

CATEGORY: Other; Ankle; Hindfoot; Midfoot/Forefoot INTRODUCTION/PURPOSE: Resilience is defined as the ability to recover after stressful events and has been shown to correlate with surgical outcomes across multiple fields. To date, there has been minimal research on the impact of patient resiliency on outcomes of foot and ankle surgery. Thus, this study aimed to look for an association between resilience, as measured by the Brief Resilience Scale (BRS); pain, as measured by the Pain Disability Index (PDI) and Pain Catastrophizing Scale (PCS); and post-operative outcomes after foot and ankle surgery. METHODS: At a single academic medical center, a retrospective review of prospectively collected data was conducted on orthopaedic foot and ankle (n=201) and podiatric (n=7) patients who completed a pre-operative BRS and underwent surgery between 2019 and 2020 (N=208). The cohort consisted of 46 post-operative opioid users and 162 non-users. Data collected included demographics, comorbidities, diagnoses, procedure (i.e., removal of implant=22, Brostrom=15, tenolysis of flexor or extensor tendons=11, 1st MTP fusion=11, cheilectomy=10, etc.), PDI and PCS scores, complications, outcome markers, and pre- and post-operative opioid and benzodiazepine use. Data was analyzed with one-way ANOVA and linear and multivariate regressions formulated by SPSS software. RESULTS: The PDI score significantly correlated with post-operative benzodiazepine (p=.011) and opioid use (p=.006), the BRS score significantly correlated with post-operative benzodiazepine use (p=.007), and the PCS score significantly correlated with longer length of follow-up (p=.011). Pre-operative opioid use was associated with an increased rate of 30-day readmission (users=6.52%, non-users=2.47%; p<.001). The multiple regression analysis indicated that the BRS score remained significantly correlated to post-operative benzodiazepine use (p=.004). Results of the multiple regression analysis also indicated that higher PCS scores were significantly correlated with increased rates of 30-day readmission (p=.047) and longer length of follow-up (p=.005). No outcome measure was significantly correlated with PDI score, according to the multiple regression analysis. CONCLUSION: In conclusion, the PCS was not shown to be an effective tool for measuring post-operative outcomes in orthopaedic foot and ankle patients, despite evidence of the contrary in other fields of orthopaedics. Additionally, the BRS and PDI were only valuable in their association with post-operative narcotic usage. Pre-operative opioid use was shown to correlate with worse higher rates of readmission and limited follow up, as corroborated by numerous previous studies. This study did not find the BRS, PDI, or PCS as useful indicators of surgical outcomes in foot and ankle patients.