New Persistent Opioid Use Following Common Forefoot Procedures for the Treatment of Hallux Valgus

Abstract

Background: Orthopaedic surgeons are the fourth highest on the list of top prescribers of opioid analgesics by specialty and have a direct impact on opioid-related morbidity in the United States. Operative bunion correction is one of the most commonly performed elective foot surgical procedures in this country. We sought to determine the rate of new persistent opioid use following exposure to opioids after surgical treatment of hallux valgus (bunionectomy) and to identify associated risk factors. Methods: A nationwide U.S. insurance claims database, Truven Health MarketScan, was used to identify opioid-naïve patients who underwent surgical treatment of hallux valgus employing 3 common procedures from January 2010 to June 2015. The rate of new persistent opioid use (i.e., fulfillment of an opioid prescription between 91 and 180 days after the surgical procedure) among patients who filled a perioperative opioid prescription was then calculated. A logistic regression model was used to examine the relationship between new persistent use and risk factors, including surgical procedure, patient demographic characteristics, and patient comorbidities. Results: A total of 36,562 patients underwent surgical treatment of hallux valgus and filled a perioperative opioid prescription. The rate of new persistent opioid use among all patients who filled a perioperative opioid prescription was 6.2%. Patients who underwent treatment with a first metatarsal-cuneiform arthrodesis were more likely to have new persistent opioid use compared with the distal metatarsal osteotomy control group (adjusted odds ratio, 1.19 [95% confidence interval, 1.03 to 1.39]; p = 0.021). Factors independently associated with new persistent opioid use included prescribing patterns, coexisting mental health diagnoses, and certain pain disorders. Conclusions: New persistent opioid use following surgical treatment of hallux valgus affects a substantial number of patients. Understanding factors associated with persistent opioid use can help clinicians to identify and counsel at-risk patients and to mitigate this public health crisis. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

New Persistent Opioid Use and Associated Risk Factors Following Treatment of Ankle Fractures

“…35 In a similar study design, the current authors found new persistent opioid use rates ranging from 6.0% to 7.3% following common procedures for surgical correction of hallux valgus. 19…”

“…35 In a similar study design, the current authors found new persistent opioid use rates ranging from 6.0% to 7.3% following common procedures for surgical correction of hallux valgus. 19 Stable ankle fractures are most commonly treated nonoperatively, while unstable fracture patterns often represent more severe bony and soft tissue injuries and require operative fixation. 12 In our analysis, we sought to compare how injury severity might affect persistent opioid use by comparing surgical treatment of common unstable fracture patterns with a non-operatively treated stable ankle fracture.…”

“…This period was chosen to capture those who may have been treated for pain control between the date of injury and the date of definitive treatment. Consistent with prior similar studies of opioid-naïve patients, 2,4,7,13,16,19,35 patients who filled an opioid prescription in the period of 12 months to 15 days prior to the peritreatment period were excluded. Those who underwent any additional surgical procedures in the 6 months following the date of treatment of their ankle fracture were also excluded by identifying CPT-4 codes for anesthesia (Appendix 2) which were billed during that period.…”

“…33,36 Recent studies have analyzed new persistent opioid use among opioid-naïve patients following surgery, and these studies have demonstrated that persistent use is linked less to poorly controlled postsurgical pain and more to identifiable patient risk factors and prescribing patterns. 2,3,7,13,19,21,35…”

“…33,36 Recent studies have analyzed new persistent opioid use among opioid-naïve patients following surgery, and these studies have demonstrated that persistent use is linked less to poorly controlled postsurgical pain and more to identifiable patient risk factors and prescribing patterns. 2,3,7,13,19,21,35 Ankle fractures are one of the most common orthopedic injuries and represent the second most common fracture of the lower extremity behind proximal femur fractures. 12,17,29,32 Ankle fractures encompass a spectrum of injury patterns to the distal fibula and/or distal tibia malleoli, which in conjunction with the ligaments of the ankle maintain congruence of the tibiotalar joint.…”