New Persistent Opioid use After Orthopaedic Foot and Ankle Surgery

A Study of 348 Patients

Emily E. Hejna, MPH; Nasima Mehraban, MD; George B. Holmes, Jr, MD; Johnny L. Lin, MD; Simon Lee, MD; Kamran S. Hamid, MD, MPH; Daniel D. Bohl, MD, MPH

Disclosures

J Am Acad Orthop Surg. 2021;29(16):e820-e825. 

In This Article

Results

Of the 492 patients initially identified, 144 were excluded (86 patients had preoperative opioid use, 51 were out-of-state residents, 5 had revision surgery within the prior 6 months, and 2 had a diagnosis of Charcot neuropathy or other chronic neuropathic pain). The remaining 348 patients (70.7%) were retrospectively reviewed (Supplemental Table 2, http://links.lww.com/JAAOS/A692). Of those, 212 (60.9%) were ≥40 years, 210 (60.3%) identified as female, 120 (34.5%) had a BMI ≥30 kg/m2, 185 (53.2%) were married, and 128 (36.8%) had a CCI ≥2. Fifteen (4.3%) patients were current smokers, 56 (16.1%) consumed ≥6 drinks per week, and 15 (4.3%) admitted to recreational drug use. Total perioperative narcotic dispensation ranged from 0 to 850 MME, with a median of 160 MME, a 25th percentile of 100 MME, and a 75th percentile of 225 MME.

Overall, the rate of new persistent opioid use was 8.9% (Supplemental Table 3, http://links.lww.com/JAAOS/A693). The risk factor with the highest rate of new persistent opioid use was recreational drug use, at 26.7% (relative risk [RR] = 3.3, 95% confidence interval [CI], 1.3 to 8.2, P = 0.014). Other risk factors for new persistent opioid use included perioperative opioid prescription >160 MME (RR = 2.2, 95% CI, 1.1 to 4.5, P = 0.021), age ≥40 years (RR = 2.2, 95% CI, 1.0 to 5.0, P = 0.049), and consumption of ≥6 alcoholic beverages per week (RR = 2.1, 95% CI, 1.0 to 4.4, P = 0.040). No other baseline characteristic achieved statistical association with new persistent opioid use, including sex, BMI, marital status, CCI, current smoker status, use of antidepressants, use of antiepileptics, use of benzodiazepines, use of muscle relaxants, ankle/hindfoot surgery (versus midfoot/forefoot surgery), bone surgery (versus soft-tissue surgery), and chronic foot/ankle condition (versus acute foot/ankle condition) (P > 0.05 for each).

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