Incidence and Risk Factors for Moderate to Severe Pain After Foot and Ankle Surgery: A Retrospective Study

Abstract

Background: Severe pain after foot/ankle surgeries is often underestimated because these procedures are perceived as less extensive than other orthopedic surgeries. However, surgeries involving the bones and joints in the foot and ankle can result in intense pain. Aims: This study aimed to identify the incidence and risk factors associated with postoperative moderate to severe pain. Design: We reviewed the medical records of 334 patients undergoing foot/ankle surgery under spinal anesthesia. The maximum numeric rating scale (NRS) pain scores were recorded at 12-hour intervals for 48 hours postsurgery, and the incidence of postoperative pain was calculated. Patients were then classified into two groups based on their maximum NRS score from the first postoperative day: those with no or mild pain (NRS score of 0-3) and those with moderate to severe pain (NRS score of 4-10). We collected variables related to the patient, surgery, and anesthesia and used logistic regression analysis to identify the factors associated with moderate to severe pain. Results: Approximately 67% of patients experienced moderate to severe pain on the first day after foot/ankle surgery, with the peak severity occurring during the initial 12 hours. Performing spinal anesthesia alone (adjusted risk ratio [ARR], 1.44; 95% confidence interval [CI], 1.21-1.71; p < .001) and hindfoot/ankle surgery (ARR, 1.22; 95% CI, 1.03-1.44; p = .020) were identified as independent risk factors for moderate to severe pain. Conclusions: Due to the high incidence of severe pain following foot/ankle surgery, patients who had spinal anesthetic alone or underwent hindfoot/ankle surgery are more likely to experience moderate to severe pain. Improved pain management measures are crucial for these patients to achieve better outcomes.