Opioid prescribing habits of podiatric surgeons following elective foot and ankle surgery

The Foot ◽  
2020 ◽  
Vol 45 ◽  
pp. 101710
Author(s):  
Rebecca A. Sundling ◽  
Daniel B. Logan ◽  
Cherreen H. Tawancy ◽  
Eric So ◽  
Jonathan Lee ◽  
...  
Keyword(s):  
Foot And Ankle ◽  
Prescribing Habits ◽  
Opioid Prescribing ◽  
Ankle Surgery

Postoperative Opioid Prescribing Practice in Foot and Ankle Surgery

2021 ◽  
Author(s):  
Brandon M Brooks ◽  
Bradley M Brooks ◽  
Brady M Brooks ◽  
Adam E Fleischer ◽  
Robert G Smith ◽  
...  
Keyword(s):  
United States ◽  
Online Survey ◽  
The United States ◽  
Practice Variation ◽  
Foot And Ankle ◽  
Linear Regression Models ◽  
Time Of Surgery ◽  
Opioid Prescribing ◽  
Ankle Surgery ◽  
Prescribing Practice

Background: Clinicians, governmental agencies, patients, and pharmaceutical companies all contribute to the United States' opioid epidemic. These same stakeholders can make meaningful contributions to resolve the epidemic by identifying ineffective habits and encouraging change. The purpose of this study was to determine if postoperative opioid prescribing practice variation exists in foot and ankle surgery. We also aimed to identify if demographic characteristics of podiatric foot and ankle surgeons were associated with their postoperative opioid prescribing practices. Methods: We administered an open, voluntary, anonymous, online questionnaire distributed on the internet via Qualtrics, an online survey platform. The questionnaire consisted of six foot and ankle surgery scenarios followed by a demographics section. We invited Podiatric foot and ankle surgeons practicing in the United States to complete the questionnaire via email from the American Podiatric Medical Association's membership list. Respondents selected the postoperative opioid(s) that they would prescribe at the time of surgery, as well as the dose, frequency, and number of "pills" (dosage units). We developed multiple linear regression models to identify associations between prescriber characteristics and two measures of opioid quantity: dosage units and MME. Results: Eight hundred and sixty podiatric foot and ankle surgeons completed the survey. The median number of dosage units never exceeded 30 regardless of the foot and ankle surgery. Years in practice correlated with reduction in opioid dosage units prescribed at the time of surgery. Conclusions: Postoperative opioid prescribing practice variation exists in foot and ankle surgery. In comparison to the orthopedic community, podiatric foot and ankle surgeons prescribe approximately 25% fewer opioids at the time of surgery than orthopedic foot and ankle surgeons. Further research is warranted to determine if additional education is needed for young surgeons.

scholarly journals Prescribing Fewer Opioid Pills to Patients Undergoing Foot and Ankle Surgery: A Prospective Comparative Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0002
Author(s):  
Kristin C. Caolo ◽  
Jonathan Day ◽  
Celia Marion ◽  
Gabrielle S. Ray ◽  
A. Holly Johnson
Keyword(s):  
Pain Management ◽  
Prospective Study ◽  
Senior Author ◽  
The Novel ◽  
Foot And Ankle ◽  
Opioid Prescribing ◽  
Ankle Surgery ◽  
Significant Difference ◽  
Sliding Scale ◽  
Established Group

Category: Ankle; Ankle Arthritis; Arthroscopy; Basic Sciences/Biologics; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma; Other Introduction/Purpose: This study aims to compare a novel opioid prescribing protocol aimed at reducing the number of opioid pills prescribed and consumed with an established, previously published protocol for foot and ankle surgery. We hypothesized that patients in the novel group would consume fewer opioids and report similar satisfaction with pain management compared with the established group. Methods: This study is a single center prospective study of 59 patients undergoing foot and ankle surgery who received a novel opioid prescribing protocol used by the senior author. Preoperatively, patients were counseled on the expectations of pain after surgery, received a take home pamphlet, and were prescribed opioids based on a sliding scale of procedures designated as minor (0-5 pills), moderate (5-10 pills) or major (15-20 pills). These patients were then compared to 84 patients from a previous prospective study from the same institution who received an opioid prescribing protocol with a maximum of 40-60 opioid pills. Patients were excluded if they used opioids or muscle relaxants preoperatively or had a known history of a substance use disorder. Patients completed surveys postoperatively for eight weeks reporting pain level, number of opioid pills consumed, refill requests, and satisfaction with their pain management plan. Results: There was a significant difference (p< 0.001) in mean pills consumed between the novel and established prescribing protocols at all time points (Table 1). During the entire postoperative period patients in the novel group had taken 21% of their prescribed pills compared to 40% in the established group (p=0.03). Patients had comparable levels of pain throughout the study (p>0.05 at POD 3, POD 7 and POD 14) and only differed significantly at POD 56 (p=0.005). Patients in the novel group did not request any refills, whereas patients in the established group requested a total of 9 refills over the course of the study. Conclusion: Patients receiving fewer opioid medications, along with preoperative coaching and take home materials, achieved equivalent analgesic effect when compared to patients receiving approximately double the amount of opioids. This study demonstrates that a sliding scale protocol with a maximum prescription of 20 opioid pills provides appropriate pain relief for most patients. This study confirms that patients on average take far fewer opioid pills than prescribed, and likely an even more limited prescribing protocol would be adequate for the majority of patients. This novel prescribing protocol ensures less opioids are both consumed and leftover for potential diversion in the community. [Table: see text]

Time and State Legislation Have Decreased Opioid Prescribing in Elective Foot and Ankle Surgery in the United States

2021 ◽  
pp. 193864002110433
Author(s):  
Daniel J. Cunningham ◽  
Nicholas F. Kwon ◽  
Nicholas B. Allen ◽  
Andrew M. Hanselman ◽  
Samuel B. Adams
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Epidemic ◽  
Foot And Ankle ◽  
Opioid Prescription ◽  
State Legislation ◽  
Filling Volume ◽  
Opioid Prescribing ◽  
Ankle Surgery ◽  
The Impact

Background Legislation in the United States has been enacted to reduce opioid overuse and abuse in the setting of the opioid epidemic, and a notable target has been opioid overprescription. However, the impact of this legislation on elective foot and ankle surgery is largely unknown. The purpose of this study was to evaluate the impact of opioid-limiting legislation on opioid prescribing in elective foot and ankle surgery. Methods The 90-day perioperative opioid prescription filling in oxycodone 5-mg equivalents was identified in all patients 18 years of age and older undergoing nontrauma, nonarthroplasty foot and ankle surgery from 2010 to 2019 using a commercial database. States with and without legislation were identified, and opioid prescription filling before and after the legislation were tabulated. Unadjusted and adjusted analyses were performed to evaluate the impact of time and state legislation on perioperative opioid prescribing in this patient population. Results Initial and cumulative opioid prescribing decreased significantly from 2010 to 2019 (39 vs 35.7 initial and 98.1 vs 55.7 cumulative). States with legislation had larger and more significant reductions in initial and cumulative opioid prescribing compared with states without legislation over similar time frames (41.6 to 35.1 with legislation vs 40.6 to 39.1 without legislation initial prescription filling volume and 87.7 to 62.8 vs 88.6 to 74.1 cumulative prescription filling volume). Conclusion State legislation and time have been associated with large, clinically relevant reductions in 90-day perioperative cumulative opioid prescription filling, although reductions in initial opioid prescription filing have remained low. These results encourage states without legislation to enact restraints to reduce the opioid epidemic. Levels of Evidence: Level III: Retrospective, prognostic cohort study

scholarly journals Ultrasound-Guided Popliteal Nerve Block with Short-Acting Lidocaine in the Surgical Treatment of Ingrown Toenails

2021 ◽  
Vol 18 (10) ◽  
pp. 5059
Author(s):  
Beom Suk Kim ◽  
Kyungho Kim ◽  
Jonathan Day ◽  
Jesse Seilern Und Seilern Und Aspang ◽  
Jaeyoung Kim
Keyword(s):  
Surgical Treatment ◽  
Adverse Events ◽  
Nerve Block ◽  
Skin Penetration ◽  
Sensory Block ◽  
Foot And Ankle ◽  
Ingrown Toenail ◽  
Ankle Surgery ◽  
Ingrown Toenails ◽  
Digital Nerve Block

Background: Digital nerve block (DB) is a commonly utilized anesthetic procedure in ingrown toenail surgery. However, severe procedure-related pain has been reported. Although the popliteal sciatic nerve block (PB) is widely accepted in foot and ankle surgery, its use in ingrown toenail surgery has not been reported. Therefore, this study aimed to investigate the safety and effectiveness of PB in the surgical treatment of ingrown toenails. Methods: One-hundred-ten patients surgically treated for an ingrown toenail were enrolled. Sixty-six patients underwent DB, and 44 underwent PB. PB was performed under ultrasound-guidance via a 22-gauge needle with 15 mL of 1% lidocaine in the popliteal region. The visual analogue scale was used to assess pain at two-time points: pain with skin penetration and pain with the solution injection. Time to sensory block, duration of sensory block, need for additional injections, and adverse events were recorded. Results: PB group demonstrated significantly lower procedure-related pain than the DB group. Time to sensory block was significantly longer in the PB group (20.8 ± 4.6 versus 6.5 ± 1.6 minutes). The sensory block duration was significantly longer in the PB group (187.9 ± 22.0 versus 106.5 ± 19.1 minutes). Additional injections were required in 16 (24.2%) DB cases, while no additional injections were required in PB cases. Four adverse events occurred in the DB group and two in the PB group. Conclusion: PB was a less painful anesthetic procedure associated with a longer sensory block duration and fewer repeat injections compared with DB. The result of this study implicates that PB can be an alternative anesthetic option in the surgical treatment of ingrown toenails.

Excess Opioid Disposal Following Orthopaedic Surgery: A Randomized Clinical Trial

2020 ◽  
pp. 193864002098092
Author(s):  
Cornelia Keyser ◽  
Abhiram Bhashyam ◽  
Abdurrahman Abdurrob ◽  
Jeremy T. Smith ◽  
Eric Bluman ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Orthopaedic Surgery ◽  
Control Group ◽  
Foot And Ankle ◽  
Opioid Medication ◽  
Ankle Surgery ◽  
Randomized Control ◽  
Level I ◽  
To Receive ◽  
Experimental Group

Background Previous research indicates low disposal rates of excess postoperative narcotics, leaving them available for diversion or abuse. This study examined the effect of introducing a portable disposal device on excess opiate opioid disposal rates after lower extremity orthopaedic surgery. Methods This was a single site randomized control trial within an outpatient orthopaedic clinic. All patients 18 years or older, undergoing outpatient foot and ankle surgery between December 1, 2017 and August 1, 2018 were eligible. Patients were prospectively enrolled and randomized to receive standard opioid disposal instructions or a drug deactivation device at 2-week postoperative appointments. Participants completed an anonymous survey at 6-week postoperative appointments. Results Of the 75 patients surveyed, 68% (n = 26) of the experimental group and 56% (n = 21) of the control group had unused opioid medication. Of these, 84.6% of patients who were given Deterra Drug Deactivation System deactivation pouches safely disposed of excess medication, compared with 38% of controls (P = .003). When asked if they would use a disposal device for excess medication in the future, 97.4% (n = 37) of the experimental and 83.8% (n = 31) of the control group reported that they would. Conclusions Providing a portable disposal device with postoperative narcotic prescriptions may increase safe disposal rates of excess opioid medication following lower extremity orthopaedic surgery. Levels of Evidence Level I

scholarly journals Medical Malpractice Trends in Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Rishin J. Kadakia ◽  
Keith Orland ◽  
Akhil Sharma ◽  
Jie Chen ◽  
Craig C. Akoh ◽  
...  
Keyword(s):  
Medical Malpractice ◽  
Orthopaedic Surgery ◽  
Nonoperative Treatment ◽  
Anatomical Location ◽  
Foot And Ankle ◽  
Common Complication ◽  
Adult Females ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
Malpractice Claims

Category: Other Introduction/Purpose: Medical malpractice lawsuits can place significant economic and psychologic burden on a provider. Orthopaedic surgery is one of the most common subspecialties involved in malpractice claims. There is currently no study examining malpractice lawsuits within foot and ankle surgery. Accordingly, the purpose of this work is to examine trends in malpractice claims in foot and ankle surgery. Methods: The Westlaw legal database was queried for lawsuits pertaining to foot and ankle surgery from 2008 to 2018. Only cases involving medical malpractice were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected such as anatomical location, pathology, complications, and case outcomes. Results: Forty nine malpractice lawsuits pertaining to foot and ankle were identified. Most plaintiffs in these cases were adult females, and the majority of cases occurred in the northeast (53.1%). The most common anatomical region involved in claims involved the forefoot (29%). The majority of these claims involved surgery (65%). Infection was the most common complication seen in claims (22%). The jury ruled in favor of the defendant surgeon in most cases (73%). Conclusion: This is the first study to examine trends in medical malpractice within foot and ankle surgery. Infection was the most frequent complication seen in claims and forefoot surgery was the most common anatomic location. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.

scholarly journals Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

2018 ◽  
Vol 40 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Johanna Marie Richey ◽  
Miranda Lucia Ritterman Weintraub ◽  
John M. Schuberth
Keyword(s):  
Risk Factors ◽  
Hormone Replacement ◽  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
History Of ◽  
Low Incidence ◽  
Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

Sign in / Sign up

Export Citation Format

Share Document