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Related Experiment Videos

The rheumatoid hand: a predictable disease with unpredictable surgical practice patterns.

Amy K Alderman1, Kevin C Chung, Sonya Demonner

  • 1The University of Michigan and the University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA.

Arthritis and Rheumatism
|October 17, 2002
PubMed
Summary

Surgical management for rheumatoid arthritis hands varies significantly by state and patient sex. Treatment patterns are not explained by surgeon availability but show distinct sex-based differences in early intervention versus reconstructive procedures.

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Area of Science:

  • Orthopedic Surgery
  • Rheumatology
  • Health Services Research

Background:

  • Rheumatoid arthritis (RA) significantly impacts hand function, necessitating surgical interventions.
  • Surgical options for RA hands include fusion, arthroplasty, and tenosynovectomy.
  • Geographic and demographic variations in surgical management are not well understood.

Purpose of the Study:

  • To assess state-level variations in fusion, arthroplasty, and tenosynovectomy rates for RA patients.
  • To investigate the relationship between hand surgeon density and surgical procedure rates.
  • To examine sex-based differences in surgical treatment for RA hands.

Main Methods:

  • Utilized the 1996-1997 Healthcare Cost and Utilization Project database.
  • Matched RA diagnostic codes with procedure codes for fusion, arthroplasty, and tenosynovectomy.

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  • Estimated RA population using US census data and national health survey prevalence rates.
  • Obtained hand surgeon density data from the American Society for Surgery of the Hand.

    • Main Results:

    • Procedure rates exhibited 9-fold to 12-fold variation across states.
    • Fusion and arthroplasty rates were highly correlated; tenosynovectomy showed moderate correlation.
    • Minimal correlation was found between surgeon density and procedure rates.
    • Women underwent more fusion and arthroplasty procedures; men had more tenosynovectomies at younger ages.

    Conclusions:

    • Significant geographic variations exist in RA hand surgery, not explained by surgeon density or demographics.
    • Reconstructive and early intervention procedures show modest correlation.
    • Sex influences surgical management: men receive earlier interventions, women receive more reconstructive surgery.