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08.04.2019 | Original Article • ANKLE - FRACTURES

Increased opioid consumption in diabetics with operative ankle fractures: a retrospective case–control study

European Journal of Orthopaedic Surgery & Traumatology
David A. Weiner, Jordan P. Murphy, Chukwuweike Gwam, Galvin J. Loughran, Christian Vulpis, David P. Milzman, Jacob M. Wisbeck
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Opioids are commonly used for post-operative pain control. It is known that diabetic patients with ankle fractures will experience prolonged healing, higher risk of hardware failure, and an increased risk of infection. However, the opioid requirements amongst this patient cohort have not been previously evaluated. Thus, the purpose of this study is to retrospectively compare opioid utilization amongst ankle fracture patients with and without diabetes mellitus (DM).


An IRB approval was obtained for the retrospective review of patients who presented with an ankle fracture and underwent surgery between November 2013 and January 2017. A total of 180 patients (144 without DM, 36 with DM) with a mean age of 50 years (± 18 years) were included. Opioid consumption was quantified utilizing a morphine-milliequivalent conversion algorithm. A repeated measures ANOVA was conducted to compare opioid consumption. A two-tailed p value of 0.05 was set as the threshold for statistical significance.


Repeated measures ANOVA revealed a statistically significant decrease in total opioid consumption during the 4-month duration (p < 0.001). The model demonstrated a mean difference in opioid consumption of − 214.3 morphine meq between the patients without and with DM (p = 0.022). Post hoc pair-wise comparison revealed less opioid consumption amongst non-diabetic patients at 2 (− 418.5 Meq; p = 0.009), 3 months (− 355.6 Meq; p = 0.021), and 4 months (− 152.6 Meq; p = 0.006) after surgery.


Our study revealed increased opioid consumption amongst diabetic patients who are treated surgically for ankle fractures. With increasing efforts aimed at reducing opioid administration, orthopaedic surgeons should be aware of higher opioid consumption amongst this patient cohort. Further studies are needed to verify the results of this study.

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