Outcomes achieved by Fellows of the Australasian College of Podiatric Surgeons

Executive summary This report summarises the findings of a 12 month study into the outcomes of foot surgery performed by Fellows of the Australasian College of Podiatric Surgeons in Western Australia. This project utilise for the first time an electronic health records “eHealth” solution to collecting real-time data and storing this information in a secure “virtual” cloud repository for instant access by the researchers. This approach attempts to reduce duplication of activity and address issues of; quality of care, patient safety and cost containment by optimising information management. Six fellows of Australasian College of Podiatric Surgeons practising in metropolitan Perth, were recruited to participate in this study. One hundred and sixty-two patients treated for orthopaedic, neurological or dermatological diseases of the foot were enrolled in this 12 month study. Approximately 90% of these subjects had private health insurance. 75% of the cohort were female (mean age 52 years) compared with their male counterparts (mean age 41 years). Older subjects tended to have multiple procedures performed. Increased age was clearly related to an increase in comorbidity (P equals 0.026). A total of 267 individual operations were performed on this cohort of patients. Orthopaedic procedures were the most commonly performed surgery (65%) followed by dermatological surgery (30%) with a smaller proportion having surgery to the nerves of their feet (5%). The vast majority of orthopaedic procedures were for the management of the first metatarsal phalangeal joint pathology (hallux abductor valgus commonly referred to as a “bunion”) and lesser digital deformity i.e (“hammer” and “claw toes”). Health status was measured preoperatively and surgical outcomes were measured 1, 3 and between 10 and 12 months post operatively. The Foot Health Status Questionnaire and the World Health Organisation Quality of Life measures were used to calculate the quality and effectiveness of surgery. Findings suggest podiatric surgeons were able to significantly improve the quality of life of orthopaedic patients one year after surgery by way of reducing patients’ level of pain and increasing their physical function. Patients’ general perceptions of foot health also improved over this time, indicating a second form of validation of outcome. On closer analysis of the specific orthopaedic procedures performed, adverse quality of life outcomes are identified in an extremely small percentage of subjects (e.g. approximately 1 to 2% of cases). This tends to reflect an extremely high standard of care is being achieved. Moreover footwear fitting and comfort with footwear proved to be an ongoing source of concern for some patients. Generic measures of health status ( WHOQOL ) did not tend to identify significant changes in health status. This lends further support to the fact region and disease specific measures of health status are more sensitive to identifying changes in health status. Patients undergoing dermatological surgery (e.g. those patients seeking care of acute and chronically ingrown and infected toenails) showed significant improvements across all foot health domains three months after surgery. This indicates excellent, effective and rapid resolution of their foot problems. Podiatric surgeons reported good experience when using the eHealth platform as a means of data collection and this approach has implications for future research.