Relationship of Duration of Wait for Surgery and Postoperative Patient-Reported Outcomes for Hallux Valgus Surgery.

Abstract

Little is known about the effect of delayed access to bunion correction (hallux valgus) surgery on patient-reported outcomes. The objective of this study was to measure the association between preoperative wait time for bunion correction surgery and postoperative patient-reported outcomes. This study prospectively recruited patients to complete preoperative patient-reported outcomes measuring depression, pain, and foot and ankle health, including the Patient Health Questionnaire-9 (PHQ-9); the pain intensity (P), interference with enjoyment (E) of life and general (G) instrument (ie, PEG); and the Foot and Ankle Outcome Score (FAOS), a condition-specific instrument. Patients complete the same patient-reported outcomes 6 months postoperatively. Regression models measured patient-reported outcomes as a function of wait time, adjusting for baseline health, age category, sex, comorbidities, and socioeconomic status. This study included 87 participants, a response rate of 53% among eligible patients. Longer waits for bunion correction surgery, adjusting for other factors, were associated with smaller gains in health in 4 of the 5 domains of the FAOS. There was no relationship between postoperative depression and pain scores with duration of wait time, adjusting for patient characteristics. At the 6-month postoperative time point, prolonged preoperative wait times were detrimental to foot and ankle outcomes in 4 of the 5 domains of the foot and ankle-specific PRO. Policies for expediting access for symptomatic hallux valgus are warranted to mitigate poorer postoperative outcomes. Further study is required to understand if failure to improve is a permanent finding in the postoperative period. Level II, prospective comparative study.