Patient and treatment related factors associated with prolonged opioid use following foot and ankle surgery: A scoping review.

BACKGROUND

The need for adequate analgesia postoperatively must be balanced against the risks of excessive or prolonged opioid use. This scoping review aims to identify the most common risk factors for prolonged or increased opioid use following foot and ankle surgery.

METHODS

A scoping review was performed according to the PRISMA guidelines. An electronic literature search was performed in PubMed, Web of Science, Embase and CINAHL. Two reviewers independently performed title/abstract and full-text screening. English language articles describing preoperative patient or treatment related factors associated with an increased risk of prolonged opioid use or increased long-term opioid dosage were included.

RESULTS

A total of 17 studies describing 223,532 patients undergoing foot and ankle surgery were included. The most commonly reported factors associated with a higher risk of prolonged or increased use of opioids were: preoperative opioid use (13 studies), mental health disorders (9 studies), tobacco use (7 studies), chronic pain disorders (7 studies), female sex (7 studies), older age (5 studies) and diabetes (4 studies). A similar distribution of risk factors was found in studies using multivariate statistical techniques to identify independent risk factors specifically.

CONCLUSIONS

Preoperative opioid use, mental health disorders, tobacco use, chronic pain disorders, female sex and older age are the most frequently reported risk factors for increased opioid use following foot and ankle surgery. These factors can be used to guide clinical decision making with regards to surgical selection criteria and in the development of targeted interventions aimed at reducing unnecessary or excessive opioid use.