Fibromyalgia Patients Have Markedly Greater Postoperative Opioid Use and Emergency Department Visits Following Bunionectomy

Submission Type: Hallux Valgus Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Fibromyalgia is a chronic disorder characterized by widespread pain, localized areas of hyperesthesia, and pervasive fatigue. Worldwide, it affects 2.7% of the population. Diagnostic criteria include point pain that notably excludes the feet and ankles without specific laboratory findings. Limited research has investigated how a fibromyalgia diagnosis affects outcomes following foot surgery, despite the prevalence of fibromyalgia in foot surgery patients which is estimated to be 13.9%. One of the most common foot conditions is hallux valgus. This deformity typically has favorable surgical outcomes, but it can cause significant pain, functional limitations, and decreased quality of life if untreated. This study aims to determine whether fibromyalgia patients experience worse postoperative outcomes, as measured by opioid usage and emergency department (ED) visits following bunionectomy. Methods: We conducted a retrospective cohort analysis using a national insurance database, Pearldiver. This database contains deidentified, longitudinal data on 161 million patients through most private and government insurance products. We identified patients who underwent bunionectomy between 2017 and 2019 using the CPT code 28296, which encompasses correction of hallux valgus with bunionectomy, with or without sesamoidectomy and distal metatarsal osteotomy utilizing any method. We stratified patients by preoperative fibromyalgia diagnosis using the ICD-10 code M797. Preoperative and postoperative opioid use within 90 days of surgery was measured using mean morphine equivalents (MME). The number of patients visiting the ED within a 6-month postoperative period and the number of admissions by each patient were collected. Fibromyalgia patients were compared to those without a diagnosis using Chi-squared tests for categorical variables and independent t-tests for continuous variables. Odds ratios (OR) were calculated for frequency data, and p< 0.01 was used for statistical significance. Results: Between 2017 and 2019, we identified 45,648 patients underwent bunionectomy, including 1,854 with fibromyalgia. Fibromyalgia patients were 3.2 times more likely to use opioids preoperatively and took 7.6 times more opioids per day. Postoperatively, they were 5.6 times more likely to take opioids and used 5.6 times more opioids per day. Fewer patients in both groups used opioids a year after surgery. Fibromyalgia patients were 5.1 times more likely to visit the ED during the six-month postoperative period. Among fibromyalgia patients, 12.7% had one visit, 10.5% had two, 5.6% had three, 3.4% had four, 2.4% had five, and 8.9% had more than five visits. No non-fibromyalgia patient visited the ED more than once in this period. This data is summarized in Table 1. Conclusion: This study shows that patients with fibromyalgia have significantly more preoperative and postoperative opioid use and significantly more emergency department admissions postoperatively. The scale of these findings is surprising, as similar research for total hip arthroplasty outcomes in fibromyalgia patients found much lower odds ratios. Given the reported coincidence of fibromyalgia in bunion patients, counseling should consider if challenges surrounding exacerbations of postoperative pain or incomplete resolution of preoperative pain outweigh a patient’s preoperative condition. Future research could investigate how postoperative bunionectomy pain compares to baseline fibromyalgia pain and if emergency admissions stem from bunionectomy pain versus other healthcare needs.