Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Orthopedic surgical interventions are associated with high cost due not only to the procedures themselves but also to the need for frequent follow-up and imaging tests. Recent orthopedic literature across several subspecialties has produced evidence suggesting that routine immediate postoperative radiographs do not provide any clinical advantage to justify their costs. This study aims to evaluate the economic feasibility of early postoperative radiographs after minimally invasive (MIS) bunion surgery.
Methods:
We retrospectively evaluated patients with hallux valgus (HV) treated with MIS bunionectomy between January 2019 and December 2024. Medical records were reviewed to assess whether radiograph findings at the first 2-week postoperative visit (FPOV) changed management of care. Direct costs of radiographs at the FPOV were estimated using Medicare Fee Schedule data (HCPCS Code 73630). National costs were estimated using Medicare data to the estimated 150,000 to 180,000 annual bunion procedures performed in the United States.
Results:
245 patients were included in our analysis. All patients received MIS bunionectomy via double osteotomy and 63 (25.7%) of patients had an additional lesser toe(s) osteotomy. 4 patients (1.6%) had a FPOV radiographic finding that warranted a change in management: 1 patient (0.4%) with loss of reduction of the first metatarsal osteotomy, 1 patient (0.4%) with a fracture through the Akin proximal phalanx osteotomy, and 2 patients (0.8%) with subluxation of lesser toe fixated via k-wire. The cost per radiographic image is $34.90 with the national estimated cost of routine radiographs for MIS bunion being $5.2m to $6.3m annually.
Conclusion:
Routine radiographs after MIS bunion surgery at 2 weeks postoperatively rarely result in change of management and are not justifiable. Asymptomatic patients without warning signs should avoid FPOV radiographs. A FPOV radiograph could be justified for patients with additional lesser toe procedures. Up to $6.3m annually could be given back to payors and patients by removing unnecessary FPOV radiograph analysis of MIS bunionectomies.