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 a nationwide US commercial insurance claims database.

METHODS: This was a retrospective cohort analysis from the IBM® Marketscan® Commercial database. Patients aged between 18-64 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 were reported one- and two-years post-surgery. All-cause reoperations were defined as presence of an additional code for hammertoe surgery without laterality as majority of the codes were without specified laterality. Generalized linear regression models controlling for demographic and clinical factors were used to compare the total payments for patients with and without infections and reoperations. The adjusted incremental payments for infection and reoperation were reported using the method of least-squares means, one- and two-years post-surgery.

RESULTS: A total of 18,540 patients (mean age 52.4 years, 78.5% females and 36.5% with Charlson Comorbidity Index ≥1) with hammertoe surgery were identified. The proportion of patients with infections over 30-, 60-, 90-, 180-days and one- and two-years post-hammertoe procedure were 1.5%, 2.6%, 3.3%, 4.3%, 6.1% and 8.9%, respectively. All-cause reoperations were reported in 11.3% over one-year and 14.5% over two-years post-surgery. The adjusted incremental payments for infection were $24,758 at one-year and $37,201 at two-year post-surgery. The adjusted incremental payments for reoperations were $12,565 at one-year and $15,807 at two-year post-surgery (All P<0.0001).

CONCLUSIONS: In this nationwide study, patients with hammertoe surgery had high rates of infection and reoperations with increased payments. Treatment alternatives are needed to lower complications rates and financial burden to healthcare system.