The Impact of Music Therapy in the Postoperative Setting on Overall Patient Satisfaction Using Validated Outcome Scores.

PURPOSE: Previous studies have examined music therapy (MT) as a potential modality to relieve negative postoperative symptoms such as pain. This randomized control trial examined the use of MT on patient satisfaction in the postanesthesia care unit. DESIGN: Fifty patients undergoing outpatient orthopaedic surgery were enrolled and randomized into two groups, those receiving MT postoperatively and a control group who did not. METHODS: After hospital discharge, subjects were assessed with two validated outcome measurements for overall patient satisfaction, the visual analog satisfaction scale and the Patient Judgment of Hospital Quality survey. FINDINGS: The results showed no statistically significant differences between the MT and control group on the Patient Judgment of Hospital Quality survey (MT = 3.42, standard therapy = 3.41, P = .94) and the visual analog satisfaction scale (MT = 91.20, standard therapy = 91.65, P = .88). CONCLUSIONS: MT given in the postoperative setting has no impact on overall patient satisfaction.

Excess Opioid Disposal Following Orthopaedic Surgery: A Randomized Clinical Trial.

BACKGROUND: Previous research indicates low disposal rates of excess postoperative narcotics, leaving them available for diversion or abuse. This study examined the effect of introducing a portable disposal device on excess opiate opioid disposal rates after lower extremity orthopaedic surgery. METHODS: This was a single site randomized control trial within an outpatient orthopaedic clinic. All patients 18 years or older, undergoing outpatient foot and ankle surgery between December 1, 2017 and August 1, 2018 were eligible. Patients were prospectively enrolled and randomized to receive standard opioid disposal instructions or a drug deactivation device at 2-week postoperative appointments. Participants completed an anonymous survey at 6-week postoperative appointments. RESULTS: Of the 75 patients surveyed, 68% (n = 26) of the experimental group and 56% (n = 21) of the control group had unused opioid medication. Of these, 84.6% of patients who were given Deterra Drug Deactivation System deactivation pouches safely disposed of excess medication, compared with 38% of controls (P = .003). When asked if they would use a disposal device for excess medication in the future, 97.4% (n = 37) of the experimental and 83.8% (n = 31) of the control group reported that they would. CONCLUSIONS: Providing a portable disposal device with postoperative narcotic prescriptions may increase safe disposal rates of excess opioid medication following lower extremity orthopaedic surgery. LEVELS OF EVIDENCE: Level I.

A Prospective Randomized Controlled Trial Comparing Physical Therapy With Independent Home Stretching for Plantar Fasciitis.

BACKGROUND: Although formal physical therapy (PT) is effective in treating plantar fasciitis (PF), it is unclear how this compares with home-based plantar fascia stretching (HS). METHODS: Fifty-seven patients with PF were enrolled in a prospective randomized trial comparing PT with HS. Visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM), and Short Form (36) Health Survey (SF-36) scores were analyzed at 6 weeks, 3 months, 6 months, and 1 year. RESULTS: At 6 months, VAS improved in both HS (35% decrease; P < 0.001) and PT (26% decrease; P = 0.002) relative to baseline. FAAM Activities of Daily Living scores improved 13.0% (P = 0.005) in HS and 21.3% (P < 0.001) in PT at 6 months relative to baseline. The SF-36 Physical Component Summary Scores demonstrated improvement at all time points in both groups. There were no notable intergroup differences in VAS, FAAM, or SF-36 at any time point. DICUSSION: The clinical outcomes of a home stretching protocol and PT did not markedly differ for the treatment of PF. LEVEL OF EVIDENCE: Therapeutic Level I.

Case Series: Allograft Tibiotalocalcaneal Arthrodesis Utilizing Fresh Talus.

BACKGROUND: Talar body osteonecrosis can be a difficult condition to treat. Recent reports highlight a high rate of failure with the use of femoral head allograft. Additionally, higher rates of failure have been reported in diabetics and smokers. Our institution attempted a novel technique utilizing fresh allograft talus in attempt to improve on a reported 50% nonunion rate. METHODS: Five patients who underwent tibiotalocalcaneal (TTC) fusion utilizing fresh talar allograft were clinically and radiographically reviewed to evaluate fusion rates and functional outcomes. RESULTS: Our case series of 5 patients had a 100% union rate, including 2 former smokers and 2 diabetic patients. There were no infections or complications. Functional outcomes also improved in our series of patients postoperatively as noted by their FAAM and SF-36 scores. CONCLUSION: TTC fusion using fresh allograft talus has a higher union rate than reported with femoral head allograft. This case series requires further study to evaluate whether this technique can be used beyond patients with osteonecrosis of the talus. LEVEL OF EVIDENCE: Level IV, case series.

Prospective Evaluation of Opioid Use After Adoption of a Prescribing Guideline for Outpatient Foot and Ankle Surgery.

BACKGROUND: In 2016, our provider group adopted an initial prescription opioid maximum guideline to reduce overprescription of opioids. The purpose of this study was to prospectively assess opioid consumption patterns following implementation of this guideline in patients undergoing outpatient foot and ankle surgery. METHODS: Over a 1-year period, we prospectively analyzed opioid prescription and use patterns of 303 consecutive patients. Opioid consumption was verified by pill counts completed at the 2- and 6-week postoperative visits. The morphine equivalent dose was calculated for each prescription and converted to the equivalent 5-mg oxycodone "pill." We used the regression coefficients from a regression model of opioid consumption to create a revised guideline for maximum initial opioid prescriptions based on patient age, bony vs nonbony procedure, and anatomic location (forefoot/midfoot/hindfoot/ankle). RESULTS: On average, 37.4 pills were prescribed and 18.9 pills used (47.6% utilization). Only 17.2% of patients used their full prescription quantity. By 2 weeks, 88% of patients no longer used opioids. Only 1.3% of patients used prescription opioids beyond 6 weeks. Independent risk factors for increased opioid consumption were younger age (P = .003), male sex (P = .007), recent preoperative opioid use (P = .019), bony procedures (P < .001), and ankle/hindfoot procedures (P = .016 and P < .001). CONCLUSION: This study showed the amount of opioid consumption for patients undergoing foot and ankle procedures. We present a modified guideline for the maximum initial prescription of opioids following outpatient foot and ankle procedures that can be used as a benchmark for further study in decreasing overprescribing. LEVEL OF EVIDENCE: Level II, prospective observational cohort study.