Summary

This study examines post-operative opioid usage and associated patient outcomes within a cohort of patients at our institution who underwent ankle fracture fixation.

Abstract

Background

Chronic opioid abuse is one of the greatest public health challenges in the United States. While primary care and chronic pain management physicians may prescribe the majority of the opioids in the US, the most common first exposure to opioids comes from acute care prescriptions, such as those written after surgery. Moreover, these opioids are often prescribed in excess, with current estimates suggesting ~75% of the pills prescribed are unused.

Ankle fractures are the most common operatively treated fracture in orthopaedic surgery. However, management of acute pain following ankle fracture surgery is challenging and the optimal perioperative pain regimen is still a point of controversy. Only recently has opioid consumption following foot and ankle surgery been studied. There is currently limited data available regarding the appropriate amount of opioid to prescribe following ankle fracture surgery.

This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid over-prescription.

Methods

Chart review and phone survey were performed on sixty-one adult patients within three to twelve months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education.

Results

43% of patients reported that they were given “more” or “much more” opioid medication than needed, 52% stated that they were given the “right amount”, and 5% reported that they were given “less” or “much less” than needed. 24.6% were on opioids prior to operation. 72.9% did not require refill of discharge opioid prescriptions; 1.69% of patients did not fill any post-operative opioid prescription. 27.11% of patients filled their discharge prescription and at least one additional refill (mean refill = 1.53). Mean number of reported opioid pills taken after surgery was 23.3. Mean satisfaction with overall pain management at phone follow up was 8.6/10.

Conclusions

While post-operative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.