Nationwide Surgical Trends for Bunionectomies in Medicare Beneficiaries: An Increase in Lapidus Bunionectomy Procedure.

Abstract

Both orthopedic surgeons and podiatric surgeons perform the Hallux Valgus (HV) Bunionectomy, yet limited information exists on which procedures are being performed more often and which specialty is performing them.. This study aims to analyze specialty-specific trends in treatment for HV within the Medicare population. In a retrospective analysis, data for bunionectomies from 2013 to 2022 were obtained from the Centers for Medicare & Medicaid Services. Bunionectomies were identified using Current procedural terminology [CPT] codes (28292, 28296, 28297, 28298, 28299 from 2013-2022 and 28295 from 2017-2022). The results were further categorized based on operator type (orthopedist, podiatrist) and place of service (inpatient, outpatient, other). Work Relative Value Units (wRVU) were calculated for osteotomy and Lapidus procedures. 217,750 bunionectomies were identified. From 2013 to 2022, the number of bunionectomies declined from 81.48 to 42.18 per 100,000 patients, a decrease of 48.23%. Orthopedic surgeons had a 9.8% increase in relative procedure share of bunionectomies performed and a 12.95% decrease in bunionectomies performed per 100,000 patients compared to a 9.8% decrease and 54.12% decrease, respectively, for podiatrists. There was a 67.32% increase in Lapidus procedures (CPT Code: 28297) performed per 100,000 patients from 2013 to 2022. Outpatient services increased by 0.1%, inpatient increased by 0.1%, and other places decreased by 0.2%.There was a substantial decline in bunionectomies performed in the Medicare population between 2013 to 2022 with an increase in the number of Lapidus procedures. Trends show an increase in utilization of orthopedic surgeons for bunionectomies and minimal change in place of service.