Risk Factors for Failure in Hammertoe Surgery.

BACKGROUND: Hammertoe correction is perhaps the most common elective surgery performed in the foot, yet rates of symptomatic recurrence and revision surgery can be high. In this study, we aimed to identify patient and provider risk factors associated with failure after hammertoe surgery. METHODS: Consecutive patients with a minimum of 6 months' follow-up undergoing hammertoe surgery within a single, urban foot and ankle practice between January 1, 2011, and December 31, 2013, served as the basis of this retrospective cohort study. Cox regression analysis was used to identify important predictor variables obtained through chart and radiographic review. One hundred fifty-two patients (311 toes) with a mean age of 60.8 ± 11.2 years and mean follow-up of 29.5 ± 21.2 months were included. RESULTS: Statistically significant predictors of failure were having a larger preoperative transverse plane deviation of the digit (hazard ratio [HR], 1.03 for each degree; P < .001; 95% CI, 1.02, 1.04), operating on the second toe (vs third or fourth) (HR, 2.23; P = .003; 95% CI, 1.31, 3.81), use of a phalangeal osteotomy to reduce the proximal interphalangeal (PIP) joint (HR, 2.77; P = .005; 95% CI, 1.36, 5.64), and using less common/conventional operative techniques to reduce the PIP joint (HR, 2.62; P = .03; 95% CI, 1.09, 6.26). Concomitant performance of first ray surgery reduced hammertoe recurrence by 50% (HR, 0.51; P = .01; 95% CI, 0.30, 0.87). CONCLUSION: We identified risk factors that may provide guidance for surgeons during preoperative hammertoe surgery consultations. This information may better equip patients with appropriate postoperative expectations when contemplating surgery. LEVEL OF EVIDENCE: Level III, retrospective case series.

Evaluating the effectiveness of air quality interventions.

Evaluating the extent to which air quality regulations improve public health--sometimes referred to as accountability--is part of an emerging effort to assess the effectiveness of environmental regulatory policies. Air quality has improved substantially in the United States and Western Europe in recent decades, with far less visible pollution and decreasing concentrations of several major pollutants. In large part, these gains were achieved through increasingly stringent air quality regulations. The costs associated with compliance and, importantly, the need to ensure that the regulations are achieving the intended public health benefits underscore the importance of accountability research. To date, accountability research has emphasized measuring the effects of actions already taken to improve air quality. Such research may also contribute to estimating the burden of disease that might be avoided in the future if certain actions are taken. The Health Effects Institute (HEI) currently funds eight ongoing studies on accountability, which cover near-term interventions to improve air quality including (1) a ban on the sale of coal, (2) replacing old wood stoves with cleaner ones, (3) decreasing sulfur content in fuel, (4) measures to reduce traffic, and (5) longer term, wide-ranging actions or events (such as complex changes associated with the reunification of Germany). HEI is also funding the development of methods and research to assess regulations that are implemented incrementally over extended periods of time, such as Title IV of the 1990 Clean Air Act Amendments, which reduces sulfur dioxide emissions from power plants in the eastern United States.