Patients with Opioid Use Disorder Have Increased Readmission Rates, Emergency Room Visits, and Costs Following Hallux Valgus Procedures

• Main Authors: James M. Parrish, Rushabh M. Vakharia MD, Dillon Benson, Aaron K. Hoyt BS, Nathaniel W. Jenkins BS, Jonathan R. Kaplan MD, Augustus J. Rush MD, Martin W. Roche MD, Amiethab A. Aiyer MD
• Format: Article
• Language: English
• Published: SAGE Publishing 2020-10-01
• Series: Foot & Ankle Orthopaedics
• Online Access: https://doi.org/10.1177/2473011420S00380

Category: Ankle; Bunion; Midfoot/Forefoot; Other Introduction/Purpose: Patients with a history of opioid use disorder (OUD) have been shown to incur more severe medical complications, higher readmission rates, and increased cost following various orthopedic procedures. There is a scarcity in the literature investigating the effects of OUD following a hallux valgus procedure. Therefore, the purpose of this study was to evaluate whether OUD patients undergoing a hallux valgus correction are at greater odds of: 1) readmission rates, 2) emergency room (ER) visits, and 3) costs. Methods: Patients undergoing a hallux valgus correction with a history of OUD were identified using a health insurance claims database. To search for patients undergoing hallux valgus surgical corrections the following current procedural terminology (CPT) medical codes were used: 28290, 28292, 28293, 28294, 28296, 28297, 28298, 28299, 28306, and 28307. To include all eligible patients the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were also utilized, including: 77.51 and 77.59. OUD patients were matched to non-opioid use disorder (NUD) patients in a 1:4 ratio by age, sex, Elixhauser-Comorbidity Index (ECI), diabetes mellitus, hyperlipidemia, hypertension, and tobacco use. Primary outcomes analyzed included odds of 90-day readmission rates, 30-day emergency room visit, and 90-day episode of care costs. Pearson’s chi-squared test was used to compare demographics. Logistic regression analysis calculated odds-ratios for readmission and ER visits. Welch’s t-test was used for significance in ECI and cost between cohorts. Results: The query yielded 6,318 patients (OUD=1,276; NUD=5,042) who underwent a hallux valgus correction. There were no significant difference between any of the compared age ranges (p=0.859, p=0.952, p=0.909, p=0.961), ECI (p=1.000) and comorbidities between OUD and NUD patients. OUD patients had higher incidence and odds of 90-day readmission rates (9.56 vs. 6.04%; OR: 1.55, p<0.001) and 30-day ER visits (.86 vs. .35%; OR: 2.42, p=0.021) compared to controls. OUD patients also incurred significantly greater 90-day episode of care costs ($7,208.28 vs. $6,134.75, p<0.0001) compared to NUD patients. Conclusion: Patients with a history of OUD who underwent a hallux valgus correction had a higher odds ratio of 90-day readmission rates, 30-day emergency room visits, and 90-day total global episode of care cost compared to those with NUD. These findings expand on a rapidly growing body of current literature that demonstrate OUD increases numerous costs associated with outcomes of foot and ankle surgery. OUD is a risk factor for poor post operative outcomes for patients undergoing a hallux valgus correction. The findings of this study are likely to improve preoperative counseling and selection when addressing patients with preoperative opioid use.