Treatment Patterns and Disparities in Thumb Collateral Ligament Surgery: A 10-Year New York State Analysis

Background: Thumb metacarpophalangeal (MCP) collateral ligament injuries are common and can be debilitating, with prolonged recovery and functional limitation of the injured hand. The aim of this study is to identify potential demographic differences between patients treated operatively and nonoperatively and identify trends in the surgical management of thumb MCP ligament injuries in New York (NY) State. Methods: Using the Statewide Planning and Research Cooperative System (SPARCS) database and relevant diagnosis codes, 18,171 patients diagnosed from 2010 through 2020 in NY State were identified. Demographic information, including age, sex, race and insurance type, was collected. Comparisons between the operative and nonoperative groups were performed using t-tests or Chi-squared tests as appropriate. The change in percentage of injuries treated operatively, as well as the effects of age, sex, race and insurance type on odds of undergoing surgery, were evaluated using linear regression analysis. Statistical significance was set at p < 0.05. Results: From 2010 to 2020, there were 18,230 collateral ligament injuries. The percentage of injuries treated operatively increased over the study period, with a minimum of 25.7% in 2011 and a maximum of 35.8% in 2017. Compared to patients with Medicaid insurance, patients were significantly more likely to be treated surgically if they had private insurance (OR = 4.15, 95% CI [3.64, 4.75], p < 0.001), worker's compensation (OR = 5.28, 95% CI [4.50, 6.20], p < 0.001) or Medicare (OR = 2.73, 95% CI [2.28, 3.26], p < 0.001). Black and Hispanic patients were less likely to undergo operative management than white patients (OR = 0.52, 95% CI [0.47, 0.58] and OR = 0.45, 95% CI [0.40, 0.51], p < 0.001). Conclusions: Demographic factors, including private insurance, workers' compensation and race, appeared to impact the likelihood of undergoing surgical management. Clinicians must be cognisant of potential demographic biases when making treatment decisions. Level of Evidence: Level IV (Therapeutic).