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Foot Ankle Int. 2018 Oct 21:1071100718805964. doi: 10.1177/1071100718805964. [Epub ahead of print]

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

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1 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
2 Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
3 Department of Surgery, University of Calgary, Calgary, Alberta, Canada.



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.


bunion; depression; function; outcomes; pain


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