Acute Complications and Safety Analysis of In-Hospital vs In-Office Based Flexor Tenotomy Procedure for the Treatment of Forefoot Deformity

Category: Lesser Toes; Other Introduction/Purpose: A Flexor Tenotomy (FT) is a procedure that can be performed in a minimally invasive fashion for the treatment of a symptomatic flexible hammertoe or diabetic ulcers on the tip of the toe or dorsally over the PIP joint. Today, there is conflicting data regarding its complication rate and limited data for patient-reported outcomes following the procedure. Additionally, the safety of this procedure has not been rigorously studied in the in-hospital vs the in-office location of service. Our study looks to evaluate the rate of acute complications, recurrences, revisions, and patient-reported outcomes for both in-hospital and in-office FT procedures. Methods: A retrospective review was conducted for patients who had undergone FT procedure at Prisma Health – Midlands between February 1st, 2021, and April 31st, 2023. Data collected included demographic data, complications, revision rates, hospital readmission, and PROMIS scores preoperatively and at 3 and 6 months postoperatively. Rates of complications, revisions, readmissions, and differences between preoperative and postoperative PROMIS scores were calculated and compared between in-hospital and in-office clinical settings. Results: A total of 130 patients were evaluated. There was found to be no significant difference in the rate of complications, revisions, or readmission between the in-hospital and in-office groups (P=0.277, 0.327, 0.837, respectively). Additionally, there was a significant decrease in Pain Interference PROMIS scores at 3 and 6 months in the in-patient group and a significant increase in Physical Function PROMIS scores at 3 months in the in-office group (P=0.001, 0.028, 0.041, respectively). Finally, there was no significant difference in the change of PI, PF, or mobility PROMIS scores between the in-hospital and in-office groups at 3 (P=0.194, 0.379, 0.734, respectively) or 6 months postoperatively (P=0.364, 0.598, 0.25). Conclusion: We found similar rates of complications, revision procedures, readmissions, and change in patient-reported outcomes between FT performed in either an in-hospital or in-office setting. These findings suggest that FT is a safe and effective procedure, regardless of the clinical setting in which it is performed.