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Variation in Nonsurgical Treatment Recommendations for Common Upper Extremity Conditions
Henrica Smits Lisanne Johanna1, Suzanne Caroline Wilkens, David Ring
1From the Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Smits, Dr. Wilkens, Dr. Chen), the Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX (Dr. Ring), and the Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands (Dr. Guitton).
Background:
In orthopaedic surgery, there is known surgeon-to-surgeon variation in recommendations for surgery. Variation in recommendations for nonsurgical treatment of common upper extremity conditions for which surgery is discretionary remains unclear.
Methods:
One hundred eighty-three surgeons were included after completing six questions on six scenarios of upper extremity conditions regarding nonsurgical treatment recommendations. For one scenario, we measured the influence of reading a summary of preferred practice before making recommendations.
Results:
Variation in nonsurgical treatment recommendations was observed between surgeons and between upper extremity conditions. Surgeons that reviewed a decision support paragraph were more likely to opine that surgery would eventually be beneficial.
Discussion:
The notable variation in nonsurgical treatment recommendations indicates a substantial influence of surgeon bias in decision-making. To help ensure that decisions are consistent, surgeons may benefit from decision support and guidelines to help limit practice variation.
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