Podiatric vs orthopaedic surgery

NewsBot · Sep 17, 2019

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Surgeon Type and Outcomes After Inpatient Ankle Arthrodesis and Total Ankle Arthroplasty
A Retrospective Cohort Study Using the Nationwide Premier Healthcare Claims Database
Jimmy J. Chan, MD et al
The Journal of Bone and Joint Surgery Jan 16 2019

Background:
Two main treatments for end-stage ankle arthritis are ankle arthrodesis and total ankle arthroplasty (TAA). While both procedures can be performed either by a foot and ankle orthopaedic surgeon or a podiatrist (when within a particular state’s scope of practice), studies comparing the surgical outcomes of the 2 surgeon types are lacking. Therefore, in this study, we compared outcomes by surgeon type for TAA and for ankle arthrodesis.
Methods:
This retrospective cohort study utilized data from the nationwide Premier Healthcare claims database (2011 to 2016) regarding TAA (n = 3,674) and ankle arthrodesis (n = 4,980) procedures. Multivariable models estimated associations between surgeon type (podiatrist versus orthopaedic foot and ankle surgeon) and opioid utilization (in oral morphine equivalents [OMEs]), length of stay, and cost of hospitalization. We report percent change (compared with reference) and 95% confidence intervals (CIs).
Results:
Overall, 76.5% (n = 2,812) and 18.8% (n = 690) of TAA procedures were performed by orthopaedic foot and ankle surgeons and podiatrists, respectively; surgeon type was unknown for 4.7% (n = 172). For ankle arthrodesis, 75.3% (n = 3,752) and 18.3% (n = 912) of the procedures were performed by orthopaedic foot and ankle surgeons and podiatrists, respectively; surgeon type was unknown for 6.3% (n = 316). The proportion of TAA and ankle arthrodesis procedures performed by podiatrists increased over time, from 12.8% and 13.6% in 2011 to 24.6% and 26.0% in 2016, respectively. When adjusting for relevant covariates, procedures performed by podiatrists (compared with orthopaedic foot and ankle surgeons) were associated with increased length of stay: for TAA, +16.7% (95% CI, 7.6% to 26.5%; median, 2 days in both groups) and for ankle arthrodesis, +14.2% (95% CI, 7.9% to 20.9%; median, 3 compared with 2 days) (p < 0.05 for both). In addition, ankle arthrodesis performed by podiatrists was associated with increased cost of hospitalization: +28.5% (95% CI, 22.1% to 35.2%; median, $19,236 compared with $13,433) (p < 0.05). Differences in opioid utilization were nonsignificant in the main analysis: +10.9% (95% CI, −3.1% to 26.8%; median, 345 compared with 250 OMEs) and +2.8% (95% CI, −5.9% to 12.4%; median, 351 compared with 315 OMEs) for TAA and ankle arthrodesis, respectively.
Conclusions:
An increasing trend in the proportion of procedures performed by podiatrists was coupled with apparent increases in length of stay and cost compared with procedures performed by orthopaedic foot and ankle surgeons. Given the increasing demand for these procedures, factors associated with resource utilization, such as type of surgeon, may be increasingly important on the population level.
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NewsBot · Mar 15, 2020

Demographic Distribution of Foot and Ankle Surgeries Among Orthopaedic Surgeons and Podiatrists: A 10-Year Database Retrospective Study.
Burton A et al
Foot Ankle Spec. 2020 Mar 13

BACKGROUND:
Foot and ankle surgeries in the United States (US) are currently performed by orthopaedic surgeons or podiatrists with specialty surgical training. With the trend in healthcare now placing increased emphasis on quality and standardizing patient care, this study aimed to characterize the distribution, volume, and trends of certain foot and ankle surgeries performed in the US by both orthopaedic surgeons and podiatrists.

MATERIALS AND METHODS:
A retrospective analysis was performed using the Marketscan Claims Database (Truven Health Analytics, Ann Arbor, Michigan) which covers most privately insured patients under the age of 65 in the USA from 2005 to 2014. We searched current procedural terminology (CPT) codes for total ankle replacement (TAR), triple arthrodesis, hallux valgus correction, pilon fracture open reduction and internal fixation (ORIF), calcaneus fracture ORIF, and ankle fracture ORIF. We recorded the timing and nature of procedures along with various features associated with the surgeon and the geographic location of the treatment facility.

RESULTS:
We found that the number of foot and ankle procedures performed annually is steadily increasing. Orthopaedic surgeons are the main treating surgeon for common foot and ankle traumatic conditions or complex hind foot cases like TAR. On the other hand, our study showed that podiatrists perform almost 9 out of 10 hallux valgus correction surgeries.

DISCUSSION:
Our study showed the trends in surgical volumes and differences between surgical podiatrists and orthopaedic surgeons and the evolution of these volumes over a ten year period and differences in surgical repertoire between orthopaedists and podiatrists.
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NewsBot · May 12, 2020

Malpractice claims associated with foot surgery.
Hartnett DA et al
Orthop Rev (Pavia). 2020 Apr 28;12(1):8439. doi: 10.4081/or.2020.8439. eCollection 2020 Apr 22.

Surgery of the foot constitutes a substantial portion of orthopedic procedures, performed by both orthopedic surgeons and doctors of podiatric medicine. Little research exists on the medicolegal implications of foot surgery amongst these specialties. This study seeks to investigate the different medical and legal factors associated with foot surgery-based malpractice litigation. Malpractice data between 2004 and 2017 was collected using the VerdictSearch legal database. Cases involving foot surgery were identified, and case information including physician specialty, procedure, medical outcome, verdict, and payment amount were obtained. A total of 72 cases were analyzed. A majority of lawsuits involved podiatrists (76.4%), with orthopedic surgeons accounting for 15.3%. Lawsuits against podiatrists primarily occurred over elective procedures (94.5%) and most frequently involved plaintiff complaints of persistent pain (41.8%) or deformation (27.3%). Podiatrist cases most often involved allegations of failure to treat (45.5%) or inappropriate surgical procedure (27.3%). Orthopedic surgeons saw higher rates of urgent cases (45.5%), with surgical complications (27.3%) occurring at higher rates than podiatrists. Despite different trends in case types, similar rates of plaintiff victories, and mean payments were seen between podiatrists (25.5%, $911,884 ± 1,145,345) and orthopedic surgeons (27.3%, $975,555 ± 448,795). This investigation is the first to analyze malpractice trends amongst podiatrists and orthopedic surgeons. Differing factors related to medical and legal outcomes can suggest quality improvement targets for both specialties. This data may assist in reducing malpractice risk and refining patient care, particularly with regards to outlining risks, benefits, and alternatives during pre-operative counselling.
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NewsBot · Mar 23, 2021

Orthopedic Versus Podiatric Care of the Foot and Ankle: A Literature Review
Charlotte Allen et al
Orthop Clin North Am. 2021 Apr;52(2):177-180

As the scope of podiatric surgery expands, the relative roles and outcomes of orthopedic surgeons and podiatrists need to be defined. With growing demand for foot and ankle services, the roles of podiatrists and orthopedic surgeons are increasingly overlapping. Few studies have examined the overlapping scope of practice of each of the groups or compared the relative costs and outcomes associated with each.
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NewsBot · Jan 17, 2022

Understanding Patient Preference of Providers to Treat Foot and Ankle Disorders
Jonathan Kraus et al
Clin Med Res. 2022 Jan 12

Objective: The purpose of this study is to evaluate patients' knowledge of the professional training between podiatry (DPM) and orthopedic surgery, patients' confidence in understanding these differences, and factors that are important to patients when selecting a provider.

Design: A 28-question survey was administered to new patients who were referred to the foot and ankle service in an orthopedic department. Survey questions included data on patient demographics, patient opinion, and knowledge of differences between podiatrists and orthopedic surgeons.

Setting: Patient surveys were administered at Froedtert Memorial Lutheran Hospital in Wauwatosa, WI and the Mayo Clinic in Jacksonville, FL.

Participants: 186 patients completed the survey.

Methods: Study population characteristics and survey results were analyzed with variance (ANOVA), Fisher's Exact test, binomial tests, and chi-square tests.

Results: Of the 186 patients who completed the entire survey, 108 chose "orthopedic surgeon" as their provider of preference for any foot or ankle injury. Patients preferred an orthopedic surgeon over a DPM for ankle (65.7% vs. 9.6%, p<0.01) and knee injuries (86.0% vs. 5.0%, p<0.01), while they preferred a DPM for toe pain (29.4% vs. 42.2%, p<0.03). 80.8% of patients thought orthopaedic surgeons and podiatrists undergo the same professional training.

Conclusions: Patients have poor understanding of the different provider training between a DPM and orthopedic surgeon. Patients showed a preference based on anatomic location with podiatrist favored for conditions affecting the toes. Those patients that demonstrate a higher level of actual knowledge were more likely to prefer an orthopaedic surgeon. Other factors, such as physician interpersonal skills and provider availability, may be more important for patients than training backgrounds.
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NewsBot · Mar 8, 2022

Increased Complication Rate Associated with Podiatric Surgery
Caroline P Hoch, Daniel J Scott, Daniel L Brinton, Lizmarie Maldonado, Christopher E Gross
Foot Ankle Orthop. 2022 Jan 21;7(1)

Introduction/Purpose:: Nationally, there has been an increase in the scope of practice between orthopaedic surgeons and podiatrists. However, there is a paucity of studies in the literature comparing outcomes between orthopaedic and podiatric surgeons in different areas of foot and ankle surgery.

Methods:: A retrospective analysis was conducted using 2016-2017 5% US national sample of the Medicare limited dataset (LDS). This included a total of 527 patients undergoing one of 14 CPT foot and ankle specific codes. Basic demographics, medical comorbidities, and 1-year post-surgical complications were reviewed. One-hundred and eighteen patients were operated on by a podiatrist versus 409 who were operated on by a physician. Mean age was 69. Common procedures included gastrocnemius recession (n=168), ankle fracture open reduction internal fixation (168), and Achilles tendon repair (72). Continuous variables were compared using Wilcoxon-Mann Whitney test and categorical variables with chi-squared test. In addition, a multivariable regression was performed, evaluating the impact of various factors on odds of complication.

Results:: Between cohorts, there were no statistically significant differences in demographics, Charlson Score, COPD, hypothyroidism, hypertension, or obesity. There was a higher rate of peripheral vascular disease in patients treated by a podiatrist versus a physician (8.5% vs. 2.4%; P=.0025). Univariate analysis showed complication rates were higher among podiatrist compared to physicians (29.7% vs. 18.8%; P=.0113). Specifically, there were high rates of complications for bunion correction (4.2% vs. 1.0%; P=.0160), diabetic wound infection (11.0% vs. 1.5%; P<0.0001), and plantar fascia release (7.6% vs. 0.1%; P=.0001). Multivariable logistic regression showed patients operated on by a podiatrist had 84.1% greater odds of suffering a complication than those operated on by a physician (OR: 1.84, 95% CI: 1.15-2.96).

Conclusion:: Surgical treatment of multiple types of foot and ankle conditions by orthopaedic surgeons was associated with lower complication rates when compared with podiatrists. The reasons for these differences are likely multifactorial, but warrants further investigation. Our findings have important implications for policymakers, as well as for large healthcare systems and patients when selecting a treating provider for surgical problems.
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NewsBot · Mar 8, 2022

Cost of Operative Fixation of Ankle Fractures: Comparing Orthopaedics and Podiatry
Joshua C Luginbuhl, Alexa R Deemer, Eric C Gokcen
Foot Ankle Orthop. 2022 Jan 21;7(1):2473011421S00325

Introduction/Purpose:: Ankle fractures pose a unique situation as both podiatrists and orthopaedic surgeons are licensed to treat them. Despite increasing emphasis on value-based medical care, there are few cost analyses focused on the treatment of ankle fractures. The goal of this study is to determine if there are cost differences between an orthopaedic surgeon and podiatrist to operatively manage an ankle fracture.

Methods:: Retrospective cohort study of patients who underwent ankle fracture fixation over a 22 month period at an academic level 1 trauma center. Patient data was subcategorized by surgeon type and treatment groups. Four treatment groups were included: lateral malleolus open reduction and internal fixation (ORIF), bimalleolar/trimalleolar ORIF (no posterior malleolus fixation), lateral malleolus ORIF with syndesmotic fixation, bimalleolar/trimalleolar ORIF (no posterior malleolus fixation) with syndesmotic fixation. Primary outcome was total (OR time cost + Implant cost) cost per case.

Results:: A total of 134 cases met criteria. Eighty-five cases were treated by a total of 4 orthopaedic surgeons while 49 were treated by 8 podiatrists. There was significantly longer OR time (minutes) for lateral malleolus ORIF (111 vs 134.92), lateral malleolus ORIF with syndesmotic fixation (130.53 vs 156.7), and bimalleolar/trimalleolar ORIF (no posterior malleolus fixation) with syndesmotic fixation (162.13 vs 208) when podiatry was the treating team. Average total cost per case was significantly more for lateral malleolus ORIF (+$1188.45), lateral malleolus ORIF with syndesmotic fixation (+$2259.16), and bimalleolar/trimalleolar ORIF with syndesmotic fixation (+$2837.29) when podiatry was the treating team.

Conclusion:: Lateral malleolus ORIF, lateral malleolus ORIF with syndesmotic fixation, and bimalleolar/trimalleolar ORIF with syndesmotic fixation costs less per case when performed by an orthopaedic surgeon based on OR time costs and implant costs.
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NewsBot · Oct 12, 2022

A Survey Analysis of Patient Understanding and Preferences for Podiatrists Versus Foot and Ankle Orthopaedic Surgeons
Fady Y Hijji et al
Foot Ankle Spec. 2022 Oct 11

Background: Recent studies suggest poorer outcomes and higher costs associated with patients treated by podiatrists, yet no studies have evaluated patient perception and preference for foot and ankle providers. This study aims to determine patient perception of training for podiatrists compared to orthopaedic surgeons and patient preference for type of provider seen.

Methods: A 20-question survey was administered to new patients seeing either a podiatrist or foot and ankle orthopaedic surgeon. Questions pertained to demographics, patient knowledge of their provider, perception of training requirements, number of years in professional training, and differences in surgical volume during training. Patients were asked their preference for a particular type of foot and ankle provider, and whether they perceived a difference in surgical skillset or a provider's ability to manage different pathology.

Results: In all, 147 podiatry and 115 orthopaedic patients were included in the study. Demographics were similar between groups. Both groups believed orthopedists required more years of education and surgical training. In all, 61.5% of orthopaedic patients believed that orthopedists performed more foot and ankle surgeries and were more skilled as compared to podiatrists, while only about a third of podiatry patients believed this to be true (68.7% vs 38.6%; P < .001). Most patients believed orthopedists were more skilled in treating fractures. In all, 48.7% of orthopaedic patients preferred seeing an orthopedist compared to only 3.5% of podiatry patients.

Conclusions: Our study demonstrates that patients are knowledgeable about the type of foot and ankle provider they are seeing. Most patients believe orthopaedic surgeons require more years of education and surgical training compared to podiatrists and believe they are more skilled in fracture-related surgery. Fewer podiatry patients expressed a preference for an orthopaedic surgeon. Providers must play an active role in discussing their training background prior to treating foot and ankle patients, especially in the setting of fracture-related pathology.

Clinical relevance: This study demonstrates that most patients seeking care from a podiatrist or foot and ankle orthopaedic surgeon are relatively knowledgeable about the type of provider they are seeing; however, there are some differences. Most patients understand that orthopaedic surgeons require more years of education and surgical training and also believe orthopaedic surgeons are more skilled in fracture work and taking care of arthritic conditions. In general, podiatry patients have less preference for seeing an orthopaedic surgeon; however, many of these patients are seeking care for wounds and infections. With expanding roles and scope of practice among podiatry providers, it is important that providers become more active in explaining their training background and qualifications when treating foot and ankle conditions.
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NewsBot · Nov 21, 2022

National Cost Comparisons Between Orthopaedics and Podiatry in Ankle Fracture Fixation
James Meyers, BA, Eric Gokcen, MD, […], Meghan Kelly, MD, PhD, Jashvant Poeran, MD, PhD, Alexander Lieber, MD, Joshua Luginbuhl, MD, Nicole Zubizarreta, MPH, and Ettore Vulcano, MD
source

Introduction/Purpose:
Increasing overlap exists between surgical care provided by orthopedic foot and ankle surgeons and podiatrists. Use of either specialty depends on numerous factors including perceived costs. Unfortunately, large scale cost comparisons between the two are lacking. Such data is increasingly important given the current climate of payment reform and cost containment in healthcare. Using national Medicare claims data, we therefore aimed to compare per-case Medicare payments between orthopedic foot and ankle surgeons and podiatrists for ankle fracture fixation. We additionally aimed to describe any differences between groups that may drive differences in payments.
Methods:
This IRB-exempt retrospective study included patients undergoing either unimalleolar, bimalleolar, or trimalleolar ankle fracture repair as recorded in the national Medicare Limited Data Set (2013-2019). Type of surgeon (orthopedic foot and ankle surgeon or podiatric surgeon) was determined using publicly available healthcare provider taxonomy information available from the Washington Publishing Company (www.wpc-edi.com) and maintained by the National Uniform Claim Committee (www.nucc.org); crosswalks between Medicare Specialty Code and Provider Taxonomy are publicly available. The primary outcome was total Medicare payments specific to the procedure, as a surrogate for cost (inflation-adjusted to 2019 US dollars). Additionally, patient demographics and hospital characteristics were compared between groups to determine if any specific factors associated with costs may influence group differences. Univariable tests (chi-squared and t-tests; non-parametric tests where appropriate) assessed significance of group differences.
Results:
Overall, 16,927 unimalleolar; 17,244 bimalleolar; and 11,717 trimalleolar fracture repairs were included. Of these, orthopedic surgeons performed more procedures than podiatrists (86.7% vs 13.3% for uni-; 92.4% and 7.6% for bi-; 92.2% and 7.8% for trimalleolar fracture repairs respectively). The mean and median age (71.6 - 72.7 [70-71] years) as well as the mean and median Charlson-Deyo Comorbidity Index (0.6 - 0.7 [0]) did not significantly differ between patients treated by an orthopedic surgeon or podiatrist (p = 0.157 and p = 0.890 respectively). Regionally, podiatrists saw patients more often in the West and Midwest whereas providers in the South were more often orthopedic surgeons (p < 0.001). Median procedure-specific Medicare payments for all three categories of ankle fracture repairs were significantly lower for orthopedic surgeons compared to podiatrists: $4,156 vs $4,300 for uni-, $4,205 vs $4,379 for bi-, and $4,396 vs $4,525 for trimalleolar, respectively (all p < 0.001).
Conclusion:
In this analysis comparing Medicare payments between orthopedic foot and ankle surgeons and podiatrists we found that ankle fracture fixation procedures performed by the orthopedic surgeons were less expensive and that cost differences do not appear to be driven by patient characteristics. Additionally, we were able to discern geographic differences regarding practice location of both surgeon types. These data will inform future discussions on how to optimize costs of foot and ankle surgical care.
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Podiatric vs orthopaedic surgery

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Integration of podiatric surgery within an orthopaedic department: An audit of patient satisfaction

UK podiatric surgery vs orthopaedic surgery

Orthopaedic Surgery vs Podiatric Surgery

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Interprofessional relationships between orthopaedic and podiatric surgeons in the UK.

Podiatric Skin and Nail Involvement and Biomechanical Pathology in Renal Transplant Recipients

Resident Involvement During Podiatric Surgery

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Podiatric vs orthopaedic surgery

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Integration of podiatric surgery within an orthopaedic department: An audit of patient satisfaction

UK podiatric surgery vs orthopaedic surgery

Orthopaedic Surgery vs Podiatric Surgery

Podiatric Vs Orthopaedic surgery in NHS

Interprofessional relationships between orthopaedic and podiatric surgeons in the UK.

Podiatric Skin and Nail Involvement and Biomechanical Pathology in Renal Transplant Recipients

Resident Involvement During Podiatric Surgery

Share This Page

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