Risks of Preoperative Opioid Therapy on Ankle Surgery Success

CATEGORY: Ankle; Hindfoot INTRODUCTION/PURPOSE: Past studies have found that preoperative chronic opioid therapy correlates with increased opioid use post-operatively as well as potentially worse surgical outcomes; however, these trends have not been extensively studied in cases of hindfoot fusions or ankle replacement (TAA). Therefore, we aimed to fill this gap in the research and understand the relationship between preoperative opioid use and postoperative success in order to improve patient outcomes. We hypothesized that patients with chronic opioid use prior to surgery would have increased likelihood of postoperative opioid use, complications, and re-operation. METHODS: A retrospective review was conducted of ankle (AA), talo-navicular (TN), and tibio-talo-calcaneal (TTC) fusions, as well as TAAs from December 2014-August 2020 by a single fellowship trained foot and ankle surgeon. Pre- and postoperative opioid and other analgesic use, medical history, demographics, and surgical outcomes were reviewed. Statistical analysis was preformed using correlation, linear multivariate regression, independent-samples t-test, and one-way ANOVA. One-hundred and fifty-two patients (female=66, male=86) with mean BMI of 31.7 and mean follow-up of 1.35 years were included. Thirty-nine underwent isolated AA, 28 TTC, 85 TAA, 9 TAA + other hindfoot fusions, 1 pan-talar fusion, and 1 TN + ankle fusion. Seventeen had a history of substance abuse (i.e., EtOH, opioids, benzodiazepines, other substances). Records of preoperative opioid use were limited to 93 patients, 90-day postoperative opioid use to 81 patients, and 120-day postoperative opioid use to 73 patients. RESULTS: Preoperative opioid use was significantly associated with reoperation rate (P=.027) and continued postoperative opioid use at 90 (P<.001) and 120 days (P<.001). Preoperative benzodiazepine use was significantly associated with continued postoperative benzodiazepine use at 90 (P<.001) and 120 days (P<.001). There was no significant difference in postoperative opioid use, complications, or reoperation rate between substance abusers and other patients. Female sex (P=.029) and BMI (P=.013) were significant predictors of postoperative opioid use. Of comorbidities, mental illness was a significant predictor of postoperative opioid use (P=.022); substance abuse history (P=.006) and mental illness (P=.001) were significant predictors of postoperative benzodiazepine use. In addition, postoperative opioid use significantly differed by surgery type (fusion=64.5 MME, TAA=28.0 MME, TAA + fusion=859.6 MME; P<.001), but postoperative benzodiazepine use did not. CONCLUSION: We found that patients with pre-operative opioid use have statically significantly higher rates of re-operation and continued post-operative opioid use. We also found that on average, patients undergoing hindfoot fusion require statically significantly more narcotics than those undergoing total ankle arthroplasty. Patients and surgeons should be aware of this data to help appropriately council patients on post-operative expectations.