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Factors Associated With a Discretionary Upper-Extremity Surgery
Tom J Crijns1, David N Bernstein2, David Ring1
1Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, TX.
The Journal of Hand Surgery
|June 18, 2018
Summary
Patients who limit activities due to pain are more likely to opt for discretionary upper-extremity surgery. Addressing psychological factors may influence surgical rates.
Area of Science:
- Orthopedic surgery
- Health services research
- Patient-reported outcomes
Background:
- Nontraumatic upper-extremity surgeries are often discretionary and preference-sensitive.
- Psychological and social determinants of health are linked to increased symptoms and limitations.
Purpose of the Study:
- To identify factors associated with discretionary surgical treatment for common upper-extremity conditions.
- To explore the relationship between patient-reported outcomes and surgical decision-making.
Main Methods:
- Utilized routinely collected patient-reported outcome measures (PROMs) for conditions including de Quervain tendinopathy, ganglion cyst, trapeziometacarpal arthritis, trigger digit, and carpal tunnel syndrome.
- Employed multiple logistic regression analysis.
- Assessed physical function, pain interference, and depression using Patient-Reported Outcomes Measurement Information System (PROMIS) measures.
Main Results:
- Higher PROMIS Pain Interference scores were independently associated with discretionary operative treatment.
- Diagnoses of carpal tunnel syndrome were linked to higher rates of discretionary surgery.
- Specific treatment teams (3, 4, or 5) showed an independent association with discretionary surgical decisions.
Conclusions:
- Individuals who limit activities more due to pain are more prone to selecting discretionary surgery.
- Interventions targeting activity engagement despite pain and addressing psychosocial determinants of health may impact discretionary surgery rates.
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