Comparative Analysis of Opioid Usage Following Total Ankle Arthroplasty vs Ankle Fusion

Abstract

Category: Ankle, Ankle Arthritis Introduction/Purpose: Opiate pain medication is frequently prescribed following foot and ankle surgery for post-operative pain management. Opioid abuse has now reached epidemic levels and unfortunately become an all too common occurrence following small prescriptions of opiate pain medication. Total ankle arthroplasty and ankle fusion are two commonly performed procedures for the treatment of ankle arthritis. Understanding postoperative pain medication requirements following these procedures is useful both in the counseling of patients pre-operatively as well as in assisting surgeons with the management of postoperative pain. We aim to examine patient opioid usage following total ankle arthroplasty compared to ankle fusion and assess for potential clinical factors associated with increased post-operative opioid use. Methods: Adult patients (over 18 years of age) undergoing total ankle arthroplasty or ankle fusion were identified using CPT codes (27700, 27702, 27870, 29899) to query the Pearl Diver patient record database, a private insurance database. 1127 patients undergoing total ankle arthroplasty and 2695 patients undergoing ankle fusion were identified. Demographic data including age, sex, and medical history was collected. Patients were examined for opioid usage at pre-operative, 1-month, 3-month, 6-month, and 1-year time points. Post-operative complications and need for revision procedures within 1-year were also examined. Multivariate logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) with p<0.05 considered significant. Results: The most common age group amongst ankle arthroplasty patients was 70-74 (21.9%) and 65-69 (21.6%) for fusion. Patients undergoing fusion were more likely to have DM, HTN, morbid obesity, tobacco use, CHF, CKD, and CAD, (p<0.05). Pre- operative opioid usage was significantly higher in the fusion group, 26.9% vs.18.8% (OR 1.41, CI 1.23 -1.61, p<0.01). Post-operative usage remained higher at all time points, (p<0.01). At 12 months, 8.7% of arthroplasty patients remained on opiates compared to 17.3% for fusion, (OR 1.67, CI 1.3-2.13, p<0.001). Need for revision procedures was higher in the fusion group at 1 year, 8.4% vs. 2.9%, (p<0.001). Additionally, arthroplasty patients were more likely to suffer post-operative complications including surgical site infection and DVT, OR 2.77 (CI 2.22-3.44) and OR 1.67 (CI 1.82-2.27) respectively. Conclusion: Our analysis of opiate prescription data indicates that a higher number of patients utilized opiate medication both pre-operatively and following fusion compared to arthroplasty patients at 1-month, 3-month, 6-month, and 1-year time points. Patients undergoing fusion also demonstrated worse pre-operative medical comorbidities. Additionally, patients undergoing fusion were more likely to suffer a complication including DVT and surgical site infection. This information indicates that fusion patients may require more opiate pain medication and are at increased risk for prolonged opiate use, and the potential complications of opiate use. Further analysis is indicated to determine potential risk factors for prolonged opioid use.