The impact of preoperative opioid use on complications, readmission, and cost following ankle fracture surgery

Oladeji, Philip; Broggi, Matthew S.; Spencer, Corey C.; Hurt, John; Hernández-Irizarry, Roberto

doi:10.1016/j.injury.2021.05.011

Cited by 7 publications

(10 citation statements)

References 28 publications

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“…4,10,13,39 For lower extremity surgery, the increased use of nerve blocks and multimodal pain regimens has starkly decreased the opioid requirements of postoperative patients. 3,7,17,20,22,26,28,[33][34][35]38,43,42 Based on a pilot study conducted at our institution of patients undergoing total shoulder arthroplasty without perioperative opioid containing medications, 19 we sought to repeat the study with patients undergoing forefoot surgery including hallux valgus and hallux rigidus procedures, along with concomitant adjacent hammertoe corrections. The purpose of this study was to compare the effectiveness and adverse events of 2 pain control pathways for forefoot surgical patients: the standard opioid-containing perioperative pain pathway (OC), to an opioid-free multimodal pain pathway (OF).…”

Section: Introductionmentioning

confidence: 99%

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Opioid-Free Forefoot Surgery vs Traditional Perioperative Opiate Regimen: A Randomized Controlled Trial

et al. 2022

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Background: In response to the opioid epidemic, the use of multimodal pain management in orthopaedic surgery is increasing. Efforts to decrease opioid prescribing and opioid consumption among foot and ankle surgical patients are needed. The purpose of this study was to compare the efficacy and adverse events between 2 multimodal pain management pathways for forefoot surgical patients: standard opioid-containing (OC) and opioid-free (OF). Methods: This is a single-center noninferior randomized controlled trial of 51 patients undergoing forefoot surgery allocated to one of 2 perioperative pain management treatments: opioid-free, multimodal (OF, n=27 patients), or traditional opioid-containing (OC, n=24 patients). Patient characteristics, creatine markers, pain (numeric rating scale [NRS]), general health (Veterans Rand 12-Item Health Survey [VR-12]), and depression were measured preoperatively. Postoperatively, pain was measured at 24-hour, 2-week, and 6-week time points. Satisfaction with pain control, complications, and general health were measured at 2 and 6 weeks. Results: The OF group is statistically noninferior to the OC group and reported lower median pain scores at 24 hours (2 [IQR 0, 3] vs 6 [IQR 3.5, 7]; p<.0001) and 2 weeks (2 [IQR 1, 4] vs 4 [IQR 0, 3]; p=.018]. By 6 weeks, pain levels were similar between groups. More than 85% of all patients reported satisfaction with pain level at 2 weeks, which increased to >90% at 6 weeks. The VR-12 scores were similar between groups across all time points. At 2 weeks, 8 patients in each group reported constipation. By 6 weeks, all but 2 OC patients reported resolution. No other adverse events of postoperative wound complications, readmissions, medication reactions, thrombosis, or persistent pain were documented. Conclusion: In forefoot surgery, the opioid-free pain management protocol was statistically noninferior to the opioid-containing protocol in reducing postoperative pain. Level of Evidence: Level II, prospective cohort study.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Opioid-Free Forefoot Surgery vs Traditional Perioperative Opiate Regimen: A Randomized Controlled Trial

et al. 2022

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“…Patients who consumed an average of 5 to 10 OMEs had increased odds of ED visits (OR 1.40 [95% CI 1.17 to 1.68]; p = 0.001). In that same study, patients who consumed an average of more than 10 OMEs had increased odds of pain-related ED visits (OR 1.77 [95% CI 1.23 to 2.55]; p = 0.002), 90-day readmission (OR 1.64 [95% CI 1.43 to 1.87]; p < 0.001), and other ED visits (OR 1.41 [95% CI 1.25 to 1.59]; p < 0.001) [35].…”

Section: Resultsmentioning

confidence: 99%

“…2 Pain level after surgery was associated with nationality (accounted for 17% of variance); patients who were American reported higher pain intensity compared with those who were Dutch (Likert scale 2.4 vs 1.7; p < 0.001) when evaluated at time of suture removal. 2 Greater opioid medication usage was associated with lower satisfaction with pain relief (Likert scale 4.1 vs 4.5; p < 0.05) Oladeji et al [35] 2021 61,424 Ankle fractures Daily opioid use within the 6 months before surgery: 2 1 to 5 OMEs was associated with increased odds of thromboembolic events (OR 1.34 [95% CI 1.10-1.62]; p = 0.003), surgical site infection (OR 1.28 [95% CI 1.07-1.53]; p = 0.007), and 90-day readmission (OR 1.22 [95% CI 1.09-1.37]; p = 0.001). 2 5 to 10 OMEs was associated with increased odds of emergency department visits (OR 1.40 [95% CI 1.17-1.68); p = 0.001).…”

Section: Other Outcomes Associated With Opioid Usementioning

confidence: 98%

Prescription Patterns, Associated Factors, and Outcomes of Opioids for Operative Foot and Ankle Fractures: A Systematic Review

Badin

Ortiz-Babilonia

Gupta

et al. 2022

Clin Orthop Relat Res

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Background Pain management after foot and ankle surgery must surmount unique challenges that are not present in orthopaedic surgery performed on other parts of the body. However, disparate and inconsistent evidence makes it difficult to draw meaningful conclusions from individual studies. Questions/purposes In this systematic review, we asked: what are (1) the patterns of opioid use or prescription (quantity, duration, incidence of persistent use), (2) factors associated with increased or decreased risk of persistent opioid use, and (3) the clinical outcomes (principally pain relief and adverse events) associated with opioid use in patients undergoing foot or ankle fracture surgery? Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for our review. We searched PubMed, Embase, Scopus, Cochrane, and Web of Science on October 15, 2021. We included studies published from 2010 to 2021 that assessed patterns of opioid use, factors associated with increased or decreased opioid use, and other outcomes associated with opioid use after foot or ankle fracture surgery (principally pain relief and adverse events). We excluded studies on pediatric populations and studies focused on acute postoperative pain where short-term opioid use (< 1 week) was a secondary outcome only. A total of 1713 articles were assessed and 18 were included. The quality of the 16 included retrospective observational studies and two randomized trials was evaluated using the Methodological Index for Non-Randomized Studies criteria and the Jadad scale, respectively; study quality was determined to be low to moderate for observational studies and good for randomized trials. Mean patient age ranged from 42 to 53 years. Fractures studied included unimalleolar, bimalleolar, trimalleolar, and pilon fractures. Results Proportions of postoperative persistent opioid use (defined as use beyond 3 or 6 months postoperatively) rangedThe authors certify that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

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“…This is consistent with prior data that have shown that orthopaedic trauma patients at baseline have a higher incidence of the above comorbidities compared with an elective outpatient population, along with prolonged opioid use after surgery, higher rates of emergency department visits, hospital readmissions, reoperations, and complications. 4,6,8,11,22 Furthermore, the risks have been shown to have an opioid dose-dependent association. 20 Our data could be useful to the orthopaedic trauma surgeon who often does not have the luxury of time to preoperatively counsel these patients as in an elective setting, but instead must set appropriate expectations almost exclusively postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Association of Preoperative Opioid Use With Postoperative Opioid Use and Patient-Reported Outcomes in Ankle Fracture Fixation Patients

Reiners

Vang

Rivard

et al. 2022

Foot & Ankle Orthopaedics

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Background: Ankle fracture surgery is a common procedure with many patients receiving opioid medications for postoperative pain control. Whether there are factors associated with higher medication quantities or patient-reported outcomes, however, remains largely unknown. Methods: Patients with isolated, rotational ankle fractures who underwent surgical fixation between January 2018 and March 2020 were retrospectively reviewed. Patient demographics, injury characteristics, and preoperative and postoperative opioid prescription information were recorded. Clinical follow-up and Foot and Ankle Ability Measure (FAAM) questionnaires were collected at 6 weeks and 3 months postoperatively. Multiple linear regression was used to examine the influences of age, sex, body mass index (BMI), fracture characteristics, medical comorbidities, and preoperative opioid use (OU) on postoperative opioid morphine milligram equivalent (MME) amount and FAAM scores. Results: A total of 294 patients were included with an average age of 52.11 ± 17.13 years (range, 18-97). Fracture types were proportional to one another. Chronic pain (mean = 145.89, 95% CI = 36.72, 255.05, P = .0009), preoperative OU (mean = 178.22, 95% CI = 47.46, 308.99, P = .0077), psychiatric diagnoses (mean = 143.81, 95% CI = 58.37, 229.26, P = .001), tobacco use (mean = 137.37, 95% CI = 33.35, 229.26, P = .0098), and trimalleolar fractures (mean = 184.83, 95% CI = 86.82, 282.84, P = .0002) were associated with higher postoperative opioid MME amounts. Older age (mean = ‒0.05, 95% CI = ‒0.08, –0.02, P = .0014) and higher BMI (mean = ‒0.06, 95% CI = ‒0.12, 0.00, P = .048) were both independently associated with lower FAAM scores at 6 weeks. At 3 months, higher BMI (mean = ‒0.09, 95% CI = ‒0.13, –0.04, P = .0002), bimalleolar fractures (mean = ‒1.17, 95% CI = ‒2.17, –0.18, P = .021), and higher postoperative MME amounts (mean = ‒0.10, 95% CI = ‒0.19, –0.01, P = .0256) were each independently associated with lower FAAM scores. Conclusion: In this study, we found that patients with chronic pain, preoperative OU, psychiatric diagnoses, tobacco use, and trimalleolar fractures were more likely to have higher amounts of opioid prescribed following ankle fracture surgery. However, only age, BMI, bimalleolar fractures, and postoperative MME amount were associated with lower FAAM scores postoperatively. Level of Evidence: Level III, retrospective cohort study.

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The impact of preoperative opioid use on complications, readmission, and cost following ankle fracture surgery

Cited by 7 publications

References 28 publications

Opioid-Free Forefoot Surgery vs Traditional Perioperative Opiate Regimen: A Randomized Controlled Trial

Opioid-Free Forefoot Surgery vs Traditional Perioperative Opiate Regimen: A Randomized Controlled Trial

Prescription Patterns, Associated Factors, and Outcomes of Opioids for Operative Foot and Ankle Fractures: A Systematic Review

Association of Preoperative Opioid Use With Postoperative Opioid Use and Patient-Reported Outcomes in Ankle Fracture Fixation Patients

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