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


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

In This Article


The findings of the present study suggest that new persistent opioid use is a prevalent complication among opioid-naive orthopaedic foot and ankle patients undergoing surgery, with about 1 in 11 such patients developing new persistent use during the postoperative period. Patients with a reported history of substance use, with greater age, or with greater alcohol use may be at particularly increased risk. The major modifiable risk factor from the orthopaedic foot and ankle surgeon's perspective is the amount of perioperative opioid prescription. Although it is inappropriate to suggest a single threshold of narcotic prescription be applied across all orthopaedic foot and ankle procedures, the present study suggests that minimizing perioperative prescription may help to prevent the development of new persistent use. Further prospective study is required to validate this concept among foot and ankle patients. Overall, a comprehensive approach to the social history and a thoughtful minimization of the perioperative prescription may aid in the prevention of new persistent use in patients undergoing orthopaedic foot and ankle surgery.