Preoperative Opioid Dependence Associated with Increased Costs and Wound Dehiscence Following Total Ankle Arthroplasty

Category: Ankle; Ankle Arthritis Introduction/Purpose: The overuse of opioid medications in patients undergoing orthopaedic surgery has become widely labeled as a national epidemic. Recent literature, particularly in the fields of orthopaedic spine surgery and joint arthroplasty, has illustrated an association between chronic opioid use and increased costs and postoperative complications. The purpose of this study is to evaluate the influence of chronic opioid dependence on postoperative outcomes following total ankle arthroplasty (TAA). We hypothesized that preoperative opioid dependence would be associated with higher rates of complications, revisions, readmissions, and mortality following TAA, as well as increased cost and longer hospital stays. Methods: The Nationwide Readmissions Database (NRD) was queried from 2015-2020 to identify 29,751 patients undergoing primary elective TAA. Patients were divided into two cohorts based on the presence of preoperative opioid dependence, with 861 (2.9%) being chronic opioid users or having opioid use disorders. Preoperative demographics, comorbidities, postoperative outcomes, cost of admission, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to identify independent predictors of postoperative outcomes other than preoperative opioid dependence. Results: The overall cohort was majority male (54.2%) with mean age of 64.15 (range 17-90) years, and Charlson-Deyo Comorbidity Index (CCI) score of 0.65 (range 0-12). When stratifying by preoperative opioid dependence, it was found that opioid dependent patients were statistically significantly older (Opioid=62.74 years; Nonopioid=65.21 years; p<.001), from lower income quartile (p=.042), more likely to have Medicaid insurance (p<.001), and had a higher CCI score (Opioid=0.97; Nonopioid=0.64; p<.001). Multivariate regression analysis of 180-day postoperative outcomes found that preoperative opioid dependence was significantly predictive of increased risk of wound dehiscence (p<.001), adverse discharge (p<.001), and extended stay greater than 4 days (p<.001). Further, preoperative opioid dependence is predictive of more than a $1,000 increase in total cost of procedure (β= 1,052.27; 95% CI= 117.62-1,986.91; p=.027). (Table1) Conclusion: Chronic preoperative opioid use was significantly predictive of higher rates of postoperative complications, LOS, and a substantially higher cost of procedure following TAA. Physicians should consider this modifiable risk factor when identifying patients and tailoring medication regimens for patients receiving ankle arthroplasty.