OBJECTIVES

: The objectives of this study were to use United States (US) Medicare Supplemental claims data to: 1) assess the rates of complications (infection, delayed healing, mechanical failure) and reoperations associated with surgical treatment of hammertoe; 2) assess the healthcare reimbursement for patients with hammertoe surgery; and 3) determine factors associated with infection after hammertoe surgery.

METHODS

: This retrospective observational cohort analysis used the IBM® Marketscan® Medicare Supplemental database (2015- 2018). All patients 65 years or older with a claim for a hammertoe procedure along with a diagnosis of hammertoe were identified. The date of the first hammertoe procedure was defined as the index date. Outcomes of interest were complications including infection, delayed healing and mechanical failure; and all-cause reoperations, without accounting for laterality, determined over two-years post hammertoe procedure. Multivariable logistic regression was conducted to determine independent factors associated with infection in hammertoe surgery.

RESULTS

: A total of 5,786 patients had hammertoe surgery. The mean (standard deviation, SD) age for the cohort was 73.0 (6.2) years with 76.7% females and 90.9% had Elixhauser score ≥1. The top three comorbid conditions were hypertension (69.1%), hypothyroidism (24.7%), and diabetes (23.0%). At two years follow-up the rates of infection, delayed healing, and mechanical failure were 27.6%, 0.1%, and 1.8% respectively. Reoperations occurred in 11.7% patients. Mean (SD) two-year reimbursement was $44,041 ($83,631). Neurological disorders (Odds ratio [OR], 95% Confidence Interval [95% CI] -1.88, 1.25-2.81), rheumatoid arthritis (OR, 95% CI- 1.55, 1.17-2.07) and depression (OR, 95% CI-1.38, 1.07-1.79) were statistically significantly associated with infection in hammertoe surgery.

CONCLUSIONS

: Among Medicare Supplemental patients with hammertoe surgery the rates of infection were high. The reoperation rate was 11.7% with a total payment of $44,041 during 2-year follow-up. Improved surgical methods and technologies could reduce non-planned reoperations thereby reducing healthcare system costs.