Patient Reported Opioid Consumption Following Outpatient Foot and Ankle Surgery

Category: opioid consumption Introduction/Purpose: The expanding opioid crisis has forced orthopedic surgeons to evaluate their prescribing practices, yet there remains limited evidence to guide providers in achieving safe and effective postoperative analgesia. Our goal was to prospectively evaluate opioid consumption following outpatient foot and ankle surgery and determine predictors of increased narcotic usage. Methods: We prospectively enrolled adult patients scheduled for outpatient foot and ankle surgery and conducted phone and in- person interviews postoperatively to determine pain level, number of pills consumed, satisfaction with pain control, and whether other analgesic medication was used. Interviews were performed at four separate time points: 5 days, 10 days, 2 weeks, and 6 weeks following surgery. Additional data collected included age, gender, payer status, education level, preoperative pain level, procedure performed, whether opioid pain medication had been used by the patient in the 12 months preceding surgery, and the amount of narcotic prescribed postoperatively. Results: Complete data was available for 52 patients (median age, 42 years). The median number of opioids prescribed postoperatively was 45 pills (337.5 morphine milligram equivalents (MMEs)). A refill narcotic prescription was provided for 36.5% of patients. The number of opioid pills consumed following surgery ranged from 0 to 120 (median, 40 pills). Forty-six percent of patients had discontinued the use of opioids by post-op day 10 and 86.5% by post-op day 20. Increased pre-operative pain level (p = 0.02) and an increased quantity of pills prescribed at the first prescription (<0.0001) were significantly associated with increased narcotic consumption. Eighteen (39.1%) patients filled a narcotic prescription in the 12 months prior to surgery, however, narcotic use prior to surgery did not significantly increase total opioid consumption. Conclusion: We found that the median number of opioids consumed following outpatient foot and ankle surgery was 40 pills. Nearly 90% of patients had discontinued narcotic use by 20 days postoperatively. Pre-operative pain level and the number of pills provided at the first prescription were predictive of increased narcotic usage.

Download Full-text

Preoperative Emotional Distress Negatively Impacts Patient-reported Outcomes Following Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00068 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0006 ◽

Cited By ~ 1

Author(s):

Sandra Klein ◽

Devon Nixon ◽

Brian Cusworth ◽

Jeremy McCormick ◽

Jeffrey Johnson

Keyword(s):

Emotional Distress ◽

Patient Reported Outcomes ◽

Functional Disability ◽

Preoperative Anxiety ◽

Foot And Ankle ◽

Preoperative Pain ◽

Residual Pain ◽

Ankle Surgery ◽

Patient Reported

Category: Other Introduction/Purpose: Prior work has demonstrated that greater preoperative emotional distress leads to worse outcomes in joint arthroplasty and spine surgery. However, there is limited data on the influence of impaired preoperative psychological function on foot and ankle outcomes. Modern tools like the Patient-Reported Outcomes Instrument Measurement System (PROMIS) can capture data such as emotional distress via the PROMIS anxiety domain. PROMIS anxiety queries symptoms of fearfulness, panic, and nervousness with scores strongly correlating to multiple legacy measures of anxiety. However, PROMIS anxiety as a surrogate for emotional distress has not been utilized in orthopedic research. We hypothesized that patients with greater preoperative emotional distress (i.e. higher PROMIS anxiety scores) would exhibit greater pain and less function than patients with lower anxiety following foot and ankle surgery. Methods: Elective foot and ankle surgeries from May 2016 – December 2016 were retrospectively identified. Patients with diabetes as well as those undergoing surgery for infection, trauma, or routine hardware removal were all excluded. PROMIS anxiety, pain interference (PI), physical function (PF), and depression scores were collected – data closest to surgery preoperatively and furthest from surgery postoperatively were used for analysis. Our study population was then grouped based on preoperative PROMIS anxiety, with scores greater than 60 indicating higher levels of emotional distress and scores below 60 indicating less impairment. A cutoff of PROMIS anxiety above 60 was selected as earlier studies have shown that threshold corresponds to clinically-significant amounts of anxiety based on traditional anxiety outcome measures. Additionally, PROMIS anxiety scores above 60 signify anxiety values one standard deviation or more away from the population average. Results: Patients with higher preoperative anxiety (average: 64.8, n=25) had greater preoperative pain and less function as compared to patients with less preoperative anxiety (average: 47.1, n=63) (PROMIS PI: 63.6 versus 59.1, P<0.01; PROMIS PF: 37.9 versus 41.7, P<0.05; respectively). Both groups of patients (i.e. high and low preoperative anxiety) demonstrated similar changes (P>0.1) in PROMIS PI and PF following surgery (? PROMIS PI: 5.1 versus 7.3;? PROMIS PF: 1.5 versus 3.0; respectively) at equivalent follow-up (5.7 versus 6.3 months, respectively). However, postoperatively, patients with higher preoperative anxiety had more residual pain and greater functional disability as compared to patients with less preoperative emotional distress (PROMIS PI: 58.5 versus 51.8, P<0.001; PROMIS PF: 39.4 versus 44.7, P<0.001; respectively). Conclusion: Evidence of preoperative emotional distress – as assessed by the PROMIS anxiety instrument – predicted worse pain and function at early surgical follow-up. Detecting patients at-risk for poorer surgical outcomes remains a topic of interest in orthopedics. Our data suggest that the PROMIS anxiety tool could be useful in identifying such patients. It would be helpful, then, to counsel individuals with higher preoperative emotional distress that – despite significant improvements – residual pain and functional disability may persist after surgery. Continued surveillance will be necessary to determine if these between-group differences remain at longer-term follow-up.

Download Full-text

Preoperative Anxiety Effect on Patient-Reported Outcomes Following Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100719850806 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1007-1011 ◽

Cited By ~ 2

Author(s):

Devon C. Nixon ◽

Kevin A. Schafer ◽

Brian Cusworth ◽

Jeremy J. McCormick ◽

Jeffrey Johnson ◽

...

Keyword(s):

Physical Function ◽

Emotional Distress ◽

Patient Reported Outcomes ◽

Functional Disability ◽

Preoperative Anxiety ◽

Foot And Ankle ◽

Preoperative Pain ◽

Level Of Evidence ◽

Ankle Surgery ◽

Patient Reported

Background: Preoperative emotional distress has been shown to negatively influence joint arthroplasty and spine surgery, but limited data exist for foot and ankle outcomes. Emotional distress can be captured through modern tools like the Patient-Reported Outcomes Instrument Measurement System (PROMIS) anxiety domain. We hypothesized that patients with greater preoperative PROMIS anxiety scores would report greater pain and less function after foot and ankle surgery than patients with lower preoperative anxiety levels. Methods: Elective foot and ankle surgeries from May 2016 to December 2017 were retrospectively identified. PROMIS anxiety, pain interference (PI), and physical function (PF) scores were collected before and after surgery. Patients were grouped based on preoperative PROMIS scores greater or less than 59.4. A cutoff of PROMIS anxiety above 59.4 was selected as the threshold that corresponds to traditional measures of anxiety. Results: Compared to patients with less preoperative anxiety (average: 47.2, n=146), patients with higher preoperative anxiety (average: 63.9, n=59) had greater preoperative pain (PROMIS PI: 63.5 vs 59.1, P < .001) and lower physical function (PROMIS PF: 37.9 vs 42.0, P = .001). Postoperatively, patients with higher preoperative anxiety had more residual pain and greater functional disability as compared to patients with less preoperative emotional distress (PROMIS PI: 58.6 vs 52.9, P < .001; PROMIS PF: 39.8 vs 44.4, P < .001; respectively). Conclusion: Our evidence showed that preoperative emotional anxiety predicted worse pain and function at early operative follow-up. Measures of preoperative anxiety could be useful in identifying patients at risk for poorer operative outcomes, but continued study is necessary. Level of Evidence: Level III, retrospective comparative study.

Download Full-text

A Prospective Evaluation of Opioid Consumption Following Orthopaedic Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00104 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0010

Author(s):

Sundeep Saini ◽

Elizabeth McDonald ◽

Kristen Nicholson ◽

Ryan Rogero ◽

Megan Chapter ◽

...

Keyword(s):

Drug Prescription ◽

Median Number ◽

Opioid Consumption ◽

Consumption Patterns ◽

Utilization Rate ◽

Foot And Ankle ◽

Narcotic Drug ◽

Opioid Prescription ◽

Forefoot Surgery ◽

Ankle Surgery

Category: Other Introduction/Purpose: The purpose of our study was to assess opioid consumption patterns 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 prospective information collected: patient demographics, preoperative health history and Visual Analog Scale (VAS), anesthesia type, procedural details, and opioid prescription and consumption details. Utilization rates were compared using the Man-Whitney Test or the Kruskall-Wallis analysis of variance test with post-hoc Dunn’s multiple comparison test. Results: A total of 1,009 of 1,027 patients were included in this study (mean age: 49 years). Overall, patients consumed a median of 20 pills whereas the median number of pills prescribed was 40. This resulted in a utilization rate of 51% and nearly 21,196 pills left unused. Patients who received forefoot surgery used 6 pills less than those receiving hindfoot/ankle surgery (p=0.002). Patients between the ages of 60-79 consumed significantly less than those between 18-59 years old (p<0.012). Patients with preoperative VAS score =77 (p=0.002) or self-reported anxiety (p=0.070) a had an increase in opioid consumption compared to those who did not. Conclusion: Our study demonstrates that patients who undergo orthopaedic foot and ankle procedures are overprescribed narcotic 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.

Download Full-text

Prospective Evaluation of Utilization Patterns and Prescribing Guidelines of Opioid Consumption Following Orthopedic Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100718790243 ◽

2018 ◽

Vol 39 (11) ◽

pp. 1257-1265 ◽

Cited By ~ 21

Author(s):

Sundeep Saini ◽

Elizabeth L. McDonald ◽

Rachel Shakked ◽

Kristen Nicholson ◽

Ryan Rogero ◽

...

Keyword(s):

Standard Error ◽

The United States ◽

Median Number ◽

Opioid Consumption ◽

Utilization Rate ◽

Foot And Ankle ◽

Level Of Evidence ◽

Opioid Prescription ◽

Factors Associated ◽

Patient Reported

Background: Overprescription of narcotic pain medication is a major culprit in the present opioid epidemic plaguing the United States. The current literature on lower extremity opioid usage has limitations and would benefit from additional study. The purpose of our study was to prospectively assess opioid consumption patterns following outpatient orthopedic foot and ankle procedures. Methods: Patients undergoing outpatient orthopedic foot and ankle procedures who met inclusion criteria had the following prospective information collected: patient demographics, preoperative health history, patient-reported outcomes, anesthesia type, procedure type, opioid prescription and consumption details. The morphine equivalent dose was calculated for each prescription and then converted to the equivalent of a 5-mg oxycodone “pill.” Univariable analyses were performed to identify variables with a statistically robust association with opioid consumption for inclusion in a multivariable linear regression. A stepwise backward regression was then performed to identify independent predictors of opioid consumption. Postoperative opioid utilization was reported for 988 patients (mean age: 49 years). Results: Overall, patients consumed a median of 20 pills whereas the median number of pills prescribed was 40. This resulted in a utilization rate of 50% and 20 631 pills left unused. Independent factors associated with higher opioid consumption were anesthesia type ( P < .004), age <60 years ( P < .001), preoperative visual analog scale (VAS) pain report of >6 ( P = .008), and bony procedures ( P = .008); residual standard error 16.73 ( F7,844=14.3, P < .001). Conclusion: Our study found that patients who underwent orthopedic foot and ankle procedures were overprescribed narcotic medication by nearly twice the amount that was actually consumed. Although we identified 4 independent factors associated with opioid consumption, the large residual standard error suggests that there remains a substantial degree of unexplained variance of opioid consumption observed in the patient population. Physicians face a challenging task of setting appropriate protocols when balancing pain relief and generalizable guidelines. Level of Evidence: Level II, prospective observational cohort study.

Download Full-text

Validity of five foot and ankle specific electronic patient-reported outcome (ePRO) instruments in patients undergoing elective orthopedic foot or ankle surgery

Foot and Ankle Surgery ◽

10.1016/j.fas.2020.02.003 ◽

2021 ◽

Vol 27 (1) ◽

pp. 52-59 ◽

Cited By ~ 1

Author(s):

Mikko M. Uimonen ◽

Ville T. Ponkilainen ◽

Alar Toom ◽

Mikko Miettinen ◽

Arja H. Häkkinen ◽

...

Keyword(s):

Patient Reported Outcome ◽

Foot And Ankle ◽

Ankle Surgery ◽

Patient Reported

Download Full-text

Outcome Following Lower Extremity Nerve Block during Foot and Ankle Surgery: A Systematic Review

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00228 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0022

Author(s):

Arianna L. Gianakos ◽

Filippo Romanelli ◽

Malaka Badri ◽

Naina Rao ◽

Bart Lubberts ◽

...

Keyword(s):

Systematic Review ◽

Pain Management ◽

Postoperative Pain ◽

Continuous Infusion ◽

Nerve Block ◽

Opioid Consumption ◽

Foot And Ankle ◽

Complication Risk ◽

Prospective Comparison ◽

Ankle Surgery

Category: Ankle; Other Introduction/Purpose: The purpose of this study was to perform a systematic review of the current literature assessing the management of pain with various block techniques in the perioperative period during elective foot and ankle surgery. Methods: A review of the literature was performed according to the PRISMA guidelines. Medline, Embase, and Cochrane databases were searched on October 1, 2019. Studies were identified by using synonyms for ‘foot’, ‘ankle’, ‘pain management’, ‘opioid’ and ‘nerve block’. Inclusion criteria were studies that 1) reported and compared the outcomes following various types of peripheral nerve blocks in in foot and ankle surgery, 2) were published in the English language, and 3) were published within the last 10 years. Results: Twenty-four articles evaluating 4,640 patients were included. Sixty-seven percent were randomized controlled trials, 17% were prospective comparison studies, and 17% were retrospective comparison studies. Nerve block techniques included: femoral, adductor canal, sciatic, popliteal, saphenous, and ankle. Ropivacaine and bupivacaine were most commonly utilized. Postoperative opioid consumption and postoperative pain levels were reduced with use of PNB when compared with systemic/local anesthesia, in patients receiving combined popliteal/femoral block, and in patients receiving continuous infusion popliteal block [Table 1, Table 2]. Studies demonstrated higher satisfaction with PNB, continuous infusion, and dual injections [Table 3]. One study reported 7% neurologic related complication risk and demonstrated a higher complication rate when with popliteal versus ankle block. All other studies were equivocal or failed to mention complications. Conclusion: Optimal pain management for elective foot and ankle surgery remains controversial and an ideal protocol from a risk-benefit perspective regarding use of PNB has yet to be established. Our study demonstrates improvements in postoperative pain levels, opioid consumption, and length of stay in patients receiving a PNB when compared with systemic anesthesia. Combined PNB and dual catheter administration may improve outcomes. Unfortunately, little data has been published on risks and tradeoffs in order to help guide patients and surgeons with a well informed shared decision making model. Future studies are needed to better clarify any respective tradeoffs to these options. [Table: see text]

Download Full-text

Association Between Baseline PROMIS Scores, Patient-Provider Communication Factors, and Musculoskeletal Health Literacy on Patient and Surgeon Expectations in Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100720959017 ◽

2020 ◽

pp. 107110072095901

Author(s):

Aoife MacMahon ◽

Elizabeth A. Cody ◽

Kristin Caolo ◽

Jensen K. Henry ◽

Mark C. Drakos ◽

...

Keyword(s):

Health Literacy ◽

Pain Intensity ◽

Physical Function ◽

Mental Status ◽

Patient Perceptions ◽

Pain Interference ◽

Foot And Ankle ◽

Musculoskeletal Health ◽

Ankle Surgery ◽

Patient Reported

Background: Various factors may affect differences between patient and surgeon expectations. This study aimed to assess associations between patient-reported physical and mental status, patient-surgeon communication, and musculoskeletal health literacy with differences in patient and surgeon expectations of foot and ankle surgery. Methods: Two hundred two patients scheduled to undergo foot or ankle surgery at an academic hospital were enrolled. Preoperatively, patients and surgeons completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey. Patients also completed Patient-Reported Outcomes Measurement Information System (PROMIS) scores in Physical Function, Pain Interference, Pain Intensity, Depression, and Global Health. Patient-surgeon communication and musculoskeletal health literacy were assessed via the modified Patients’ Perceived Involvement in Care Scale (PICS) and Literacy in Musculoskeletal Problems (LiMP) questionnaire, respectively. Results: Greater differences in patient and surgeon overall expectations scores were associated with worse scores in Physical Function ( P = .003), Pain Interference ( P = .001), Pain Intensity ( P = .009), Global Physical Health ( P < .001), and Depression ( P = .009). A greater difference in the number of expectations between patients and surgeons was associated with all of the above ( P ≤ .003) and with worse Global Mental Health ( P = .003). Patient perceptions of higher surgeons’ partnership building were associated with a greater number of patient than surgeon expectations ( P = .017). There were no associations found between musculoskeletal health literacy and differences in expectations. Conclusion: Worse baseline patient physical and mental status and higher patient perceptions of provider partnership building were associated with higher patient than surgeon expectations. It may be beneficial for surgeons to set more realistic expectations with patients who have greater disability and in those whom they have stronger partnerships with. Further studies are warranted to understand how modifications in patient and surgeon interactions and patient health literacy affect agreement in expectations of foot and ankle surgery. Level of Evidence: Level II, prospective comparative series.

Download Full-text

Determining Success or Failure After Foot and Ankle Surgery Using Patient Acceptable Symptom State (PASS) and Patient Reported Outcome Information System (PROMIS)

Foot & Ankle International ◽

10.1177/1071100718769666 ◽

2018 ◽

Vol 39 (8) ◽

pp. 894-902 ◽

Cited By ~ 15

Author(s):

Michael R. Anderson ◽

Judith F. Baumhauer ◽

Benedict F. DiGiovanni ◽

Sam Flemister ◽

John P. Ketz ◽

...

Keyword(s):

Patient Outcome ◽

Patient Outcomes ◽

Roc Analysis ◽

Patient Reported Outcome ◽

Foot And Ankle ◽

Chi Square ◽

Ankle Surgery ◽

Patient Reported ◽

Patient Acceptable Symptom State ◽

Chi Square Analysis

Background: As the role of generic patient-reported outcomes (PROs) expands, important questions remain about their interpretation. In particular, how the Patient Reported Outcome Measurement Instrumentation System (PROMIS) t score values correlate with the patients’ perception of success or failure (S/F) of their surgery is unknown. The purposes of this study were to characterize the association of PROMIS t scores, the patients’ perception of their symptoms (patient acceptable symptom state [PASS]), and determination of S/F after surgery. Methods: This retrospective cohort study contacted patients after the 4 most common foot and ankle surgeries at a tertiary academic medical center (n = 88). Patient outcome as determined by phone interviews included PASS and patients’ judgment of whether their surgery was a S/F. Assessment also included PROMIS physical function (PF), pain interference (PI), and depression (D) scales. The association between S/F and PASS outcomes was evaluated by chi-square analysis. A 2-way analysis of variance (ANOVA) evaluated the ability of PROMIS to discriminate PASS and/or S/F outcomes. Receiver operator curve (ROC) analysis was used to evaluate the ability of pre- (n = 63) and postoperative (n = 88) PROMIS scores to predict patient outcomes (S/F and PASS). Finally, the proportion of individuals classified by the identified thresholds were evaluated using chi-square analysis. Results: There was a strong association between PASS and S/F after surgery (chi-square <0.01). Two-way ANOVA demonstrated that PROMIS t scores discriminate whether patients experienced positive or negative outcome for PASS ( P < .001) and S/F ( P < .001). The ROC analysis showed significant accuracy (area under the curve > 0.7) for postoperative but not preoperative PROMIS t scores in determining patient outcome for both PASS and S/F. The proportion of patients classified by applying the ROC analysis thresholds using PROMIS varied from 43.0% to 58.8 % for PASS and S/F. Conclusions: Patients who found their symptoms and activity at a satisfactory level (ie, PASS yes) also considered their surgery a success. However, patients who did not consider their symptoms and activity at a satisfactory level did not consistently consider their surgery a failure. PROMIS t scores for physical function and pain demonstrated the ability to discriminate and accurately predict patient outcome after foot and ankle surgery for 43.0% to 58.8% of participants. These data improve the clinical utility of PROMIS scales by suggesting thresholds for positive and negative patient outcomes independent of other factors. Level of Evidence: II, prospective comparative series.

Download Full-text

Trends of Foot and Ankle Publishing in JBJS[A] over a 15 Year Period From 2004-2018

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00101 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0010

Author(s):

Bradley Alexander ◽

James Hicks ◽

Abhinav Agarwal ◽

Aaradhana J. Jha ◽

Spaulding F. Solar ◽

...

Keyword(s):

Geographic Origin ◽

Median Number ◽

Foot And Ankle ◽

Level Of Evidence ◽

Quality Research ◽

Level Ii ◽

Ankle Surgery ◽

Ankle Research ◽

Quality Of Research

Category: Other Introduction/Purpose: As the field of foot and ankle surgery grows and new innovations continue to be made it is important that the quality of research improves. This will help to lay a strong foundation for current and future surgeons in the field. Leading journals need to set the tone for all orthopedic journals by publishing quality literature. This current study will look at all foot and ankle articles published by JBJS[A] over a 15-year period and analyze authorship, article type, geographic origin of articles, and level of evidence trends. This study will give a representative view of where foot and ankle research is currently and where it can go as we enter the new decade. Methods: A foot and ankle research fellow reviewed all of the articles published in JBJS[A] from January 2004 to December of 2018. Articles that related to foot and ankle topics were then selected to analyzed. Editorials, letters to the editor, announcements, technical notes, retraction notes, events, errata, retracted manuscripts, historical papers and pediatric foot and ankle articles were excluded. After exclusions were applied 321 and information pertaining to each article was analyzed. Additionally, a Google Scholar search was conducted for each article to determine the number of times an article had been cited. For calculations relating to median number of citations for each article we excluded articles that were published less than three years ago (2017 and 2018). For level of evidence a kappa value (0.82) was calculated to measure interobserver reliability between two reviewers. Results: We found the following results to be significant. Clinical therapeutic studies were the predominant study design over 15 years. The amount of literature over ankle arthroplasty has increased more than any other article topic. The amount of level IV and V evidence has decreased and the amount of level II and III evidence has increased. The median number of authors has been increasing. This includes female authorship. There has been in an increase in MD, PhDs as last authors. There is more foot and ankle research being produced by Asian countries. A majority of high level of evidence articles (level I and II) comes from North America and Europe. Level of evidence doesn’t correlate with the amount of times an article is cited. Conclusion: As the field of foot and ankle surgery continues to grow it is important that there is a high quality of research being conducted and published to guide surgical and clinical decisions. Our study shows that research is being produced more globally and the number of individuals involved in the research process is increasing and diversifying. This has led to higher quality research being produced (more level II and III) and a decrease in lower quality research (IV and V). Overall, the standard of research has increased in JBJS[A] which benefits the foot and ankle surgery community. [Table: see text]

Download Full-text

Pain course after foot and ankle surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000330 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Christian Plaass ◽

Sarah Ettinger ◽

Leif Claassen ◽

Christina Stukenborg-Colsman ◽

Kiriakos Daniilidis ◽

...

Keyword(s):

Postoperative Pain ◽

Characteristic Curve ◽

Tertiary Care ◽

Pain Level ◽

Foot And Ankle ◽

Primary Surgery ◽

Ankle Surgery ◽

The Mean ◽

One Year ◽

A Prospective Study

Category: Pain managment Introduction/Purpose: Most surgeons believe, that the postoperative pain course after foot and ankle surgery differs from other joints due to the initial protection and immobilization. The knowledge of the normal pain course after foot and ankle surgery is important to know for the surgeon and correctly inform patients preoperative and may help to identify abnormal postoperative healing courses. Methods: 180 patients were enclosed in a prospective study. 66,7% were female and 33.3% were male. All patients had primary surgery for foot and ankle diseases at a tertiary care foot and ankle center. The pain course was measured using a VAS over a one year period. The mean age was 53,2 (±13.6) years. Results: The mean pain level was 4.56 (± 2.0) preoperative. In the first postoperative week it was 3.5 (± 2.18) and declined until the 6th postoperative week to 1.57 (± 1.52) it increased again after the sixth week up to 1.95 (± 1.63) and decreased then again to 1.09 (± 1.51) one year postoperative. The pain level in patient with tendon surgeries tended to be higher in the first 12 weeks postoperative than that of patients with bony procedures. Conclusion: The pain course after Foot and ankle surgery shows a characteristic curve with a significant increase of the pain level after 6 weeks. A comprehensive patient information can increase satisfaction rates of the patient. Any abnormal postoperative pain course should arise suspection of a complicated healing period.

Download Full-text