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.

Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics, Bunion, Hindfoot, Lesser Toes, Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Managing post-operative pain in patients has become a growing concern given the increasing focus on controlling opioid use. Over the counter (OTC) analgesics such as tylenol and ibuprofen have been shown to be useful adjuncts to post-operative pain regimens and may decrease opioid use. However utilization of these adjuncts may be limited by patient education especially if they are not formally prescribed by the physcian. In this work we aim to identify how often post-operative patients utilize OTC analgesics to supplement their pain control and what are the barriers to usage. 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 and not incarcerated. Bony procedures included any osteotomy, fracture fixation, or arthrodesis. This subset of patients were then called and surveyed about their post-operative pain. 114 patients met inclusion criteria. Results: 42 patients responded to the survey. 27 (64%) of patients did not supplement their pain control with OTC analgesics. The most common reason why (13/27 patients) OTC meds were not used was because pain control on narcotics alone was sufficient. Other reasons included dislike of polypharmacy, not believing they would be efficacious, and not knowing that it is was safe to take them. Total narcotic use between the two groups was higher in the OTC group however (760 mg morphine equivalent in the no OTC group and 1073 mg morphine equivalent in the OTC group, p = 0.25). Conclusion: This study highlights the misconception of patients in regards to optimal pain control. The higher absolute narcotic usage in the OTC group may reflect that patients who feel the need to supplement their pain regimen have lower pain tolerance to begin with.