Evaluation of Opioid Consumption Patterns Following Orthopaedic Foot and Ankle Surgery

Introduction: The purpose of our study is to assess the patterns of opioid consumption following outpatient orthopaedic foot and ankle procedures in order to develop a pragmatic approach to narcotic drug prescription.

Methods: Patients undergoing outpatient orthopaedic foot and ankle procedures who met inclusion criteria had the following information collected: patient demographics, pre-operative health history, insurance type (commercial, Medicare), surgical details, current procedural terminology (CPT) and associated revenue value unit (RVU) codes, number of narcotic pills prescribed, and number of narcotic pills consumed (5-325 acetaminophen/oxycodone).

Results: A total of 636 patients were included in this study with a mean age of 49 years. Overall, patients consumed a mean of 23 pills whereas the mean number of pills prescribed was 42. This resulted in a utilization rate of 55% and 12,003 pills left unused. Patients who received forefoot surgery used 4 pills less than those receiving hindfoot/ankle surgery (p=0.014). Patient age, insurance, and surgical complexity were significantly associated with opioid consumption rates (p=0.001). Patients with self-reported anxiety had an increase in opioid consumption of 9 pills (p=0.002). History of cancer and sleep apnea were independent risk factors associated with decreased opioid consumption (p<0.05).

Discussion: Our study demonstrates that patients who undergo orthopaedic foot and ankle procedures are overprescribed opioid pain medication by nearly twice the amount that is actually consumed. This leads to a significant surplus of narcotics available for potential diversion. We recommend that surgeons judiciously administer opioid prescriptions based on their patients’ consumption patterns and anatomic location of surgery.