OBJECTIVES: This study evaluated the rates of infections and reoperations after hammertoe surgery and calculated one- and two-year incremental payments associated with infections and reoperations in older adults.

METHODS: This was a retrospective evaluation of medical claims from the United States Centers for Medicare and Medicaid Standard Analytic File (100%) sample. Patients aged ≥65 years with a diagnosis of hammertoe who underwent hammertoe procedure between 2015 and 2016 were included. Cumulative proportion of patients with a diagnosis of infection were reported 30-, 60-, 90-, 180-days and one- and two-years post-hammertoe procedure. All-cause reoperations defined as presence of an additional code for hammertoe surgery with and without known laterality were reported, one- and two-years post-surgery. Generalized linear regression models were used to evaluate the adjusted total payments for patients with and without infections and reoperations. The adjusted incremental payments associated with infection and ipsilateral reoperation were reported one- and two-years post-surgery.

RESULTS: A total of 10,624 older adults (average age 73.4 years, 77.8% females, and 54.9% with Charlson Comorbidity Index ≥1) were identified. The proportion of patients with infections over 30-, 60-, 90-, 180-days and one- and two-years post-hammertoe procedure were 1.1%, 1.9%, 2.4%, 3.1%, 4.2% and 6.5%, respectively. All-cause reoperations were reported in 6.3% of which 1.7 % were ipsilateral, 1.9% were contralateral and 2.7% were of unknown laterality over one-year post surgery. For two-years post-surgery, the all-cause reoperation rate was 9.5%: 2.2% ipsilateral, 2.2% contralateral and 5.1% unknown laterality. The adjusted incremental payments for infection and ipsilateral reoperations were $28,595 and $6,753 at one-year and $50,791 and $15,614 at two-year post-surgery, respectively.

CONCLUSIONS: Among older adults with hammertoe surgery the rates of infection and reoperations reached 6.5% and 9.5% over two-years post-surgery with increased payments. Treatment alternatives are needed to lower complications rates and financial burden to healthcare system.