Epidemiology of hallux valgus surgery in Italy: A nationwide study from 2001 to 2016

Purpose: This study intended to estimate the annual number of hallux valgus surgical procedures in Italy and the patients' epidemiological features. A secondary goal was to compare the demographic differences in access to hallux valgus surgery amongst three Italian macroregions. Methods: The analysis was conducted by using the National Hospital Discharge Records database provided by the Italian Ministry of Health. Results: 721,514 surgical procedures for Acquired Hallux valgus were performed. The cumulative incidence was 88.2 procedures for every 100,000 Italian residents. The highest number of procedures was found in the 60–64 age class. 91.2% of patients were females. The mean length of hospitalisation was 2.1 ± 2.2 days. Patients aged 95–99 had more days of hospitalisation on average. 51.9% of procedures were performed in the North, 25.7% in the Centre and 22.4% in the South. 98.5% of patients from the North received surgical treatment in the same macroregion of domicile: 90% in the Centre and 78.5% in the South. The main primary procedure was: bunionectomy with soft tissue correction and osteotomy of the first metatarsal (79.9%, 77.51 International Classification of Diseases, Ninth Revision, Clinical Modification code). Conclusions: The socio-economic burden of hallux valgus surgery in Italy is relevant. The incidence of hallux valgus surgery has progressively increased between 2001 and 2012 and decreased from 2012 to 2016. A geographically unequal distribution of procedures between the three Italian macroregions was pointed out. Migratory flows of patients from the South to the North for undergoing the procedure were observed. Level of Evidence: Level III.