Variation in recommendation for surgical treatment for compressive neuropathy

Michiel G.H. Hageman, Stephanie J.E. Becker, Arjan G.J. Bot, Thierry Guitton, David Ring, Abhijeet L. Wahegaonkar, Aida E. GarciaG, Alan Schefer, Alberto Pérez Castillo, Andrew L. Terrono, Andrew W. Gurman, T. Apard, Barry Watkins, Asif Ilyas, Bernard F. Hearon, Brian P.D. Wills, Bruce I. Wintman, Carrie Swigart, Catherine Spath, Cesar Dario Oliveira MirandaCharles A. Goldfarb, Charles Cassidy, Charles Metzger, Charles Eaton, Chris Wilson, Christopher J. Walsh, Christopher J. Wilson, Christopher M. Jones, Colby Young, Craig A. Bottke, Daniel A. Osei, D. Kay Kirkpatrick, Daniel Polatsch, David E. Tate, David L. Nelson, David M. Kalainov, David M. Lamey, Doug Hanel, David M. Ostrowski, David R. Miller, Desirae M. McKee, David Ruchelsman, Ekkehard Bonatz, Eon K. Shin, Eric P. Hofmeister, Evan S. Fischer, F. Thomas D. Kaplan, C. H. Fernandes, Jamie E. Forigua, Fidel Ernesto Cayon Cayon, Frank J. Raia, Frank L. Walter, Gary K. Frykman, Gary M. Pess, Gary R. Kuzma, Georg M. Huemer, Gregory Dee Byrd, George W. Balfour, Gladys Cecilia Zambrano Caro, German Ricardo Hernandez, Gregory DeSilva, H. Brent Bamberger, H. W. Grunwald, Hal MccUtchan, Harrison Solomon, Hervey L. Kimball, J. E.B. Stuart, Ines C. Lin, Jack Choueka, James G. Reid, James M. Boler, Jay Pomerance, Jeff W. Johnson, Jeffrey Yao, Jim Calandruccio, Jennifer B. Green, Jennifer Moriatis Wolf, Jessica A. Frankenhoff, Jerome W. Oakey, Jochen Fischer, John Howlett, John Jiuliano, John M. Erickson, John McAuliffe, John P. Evans, John Taras, Jorge G. Boretto, Jonathan Isaacs, Jose A. Ortiz, José Fernando Di Giovanni, Jose Nolla, Joshua M. Abzug, Julie Adams, L. C. Bainbridge, Karel Chivers, Karl Josef Prommersberger, Kevin J. Malone, Kendrick Lee, Lawrence S. Halperin, Lawrence Weiss, Leon Benson, Lewis B. Lane, Lior Paz, Lisa Lattanza, M. Jason Palmer, Louis Catalano, Marc J. Richard, Marco Rizzo, Martin Boyer, Maurizio Calcagni, Megan M. Wood, Michael Baskies, Michael W. Grafe, Michael Behrman, Michael Jones, Michael Quinn, Michael Nancollas, Michael W. Kessler, Miguel A. Pirela-Cruz, Milan M. Patel, Naquira Escobar Luis Felipe, Neil G. Harness, Ngozi M. Akabudike, Nicholas J. Horangic, Oleg M. Semenkin, Nicky L. Leung, Patrick T. McCulloch, Patrick W. Owens, Paul A. Martineau, Paul Bettinger, Paul Guidera, Peter E. Hoepfner, Prasad Sitaram, Peter H. DeNoble, Peter Jebson, Philip Coogan, Phani Dantuluri, R. Glenn Gaston, Ralf Nyszkiewicz, Ralph M. Costanzo, Ramon De Bedout, Randy Hauck, Renato M. Fricker, Richard S. Gilbert, Richard L. Hutchison, Richard W. Barth, Rick Papandrea, Robert M. Szabo, Robert R.L. Gray, Ross Nathan, Rozental, Sander Spruijt, Russell Shatford, Ryan Klinefelter, Samir Sodha, Ryan P. Calfee, Sanjeev Kakar, Saul Kaplan, Scott F. Duncan, Scott Mitchell, Seth Dodds, Sidney M. Jacoby, Stephen A. Kennedy, Stanley Casimir Marczyk, Stephen W. Dailey, Steve Kronlage, Steven Alter, Steven Beldner, Steven Steven J. McCabe, Stuart M. Hilliard, Thomas J. Fischer, Taizoon Baxamusa, C. Taleb, Thomas F. Varecka, Theresa Wyrick, Timothy G. Havenhill, Todd Siff, Victoria D. Knoll, Vipul P. Patel, W. Arnnold Batson, Warren C. Hammert, William J. Van Wyk

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Purpose It is our impression that there is substantial, unexplained variation in hand surgeon recommendations for treatment of peripheral mononeuropathy. We tested the null hypothesis that specific patient and provider factors do not influence recommendations for surgery. Methods Using a web-based survey, hand surgeons recommended surgical or nonsurgical treatment for patients in 2 different scenarios. Six elements of the first scenario (symptoms, circumstances, mindset, diagnosis, objective testing, and expectations) had 2 possibilities that were each independently and randomly assigned to each rater. For the second scenario, 2 different scenarios were randomly assigned to each rater. Multivariable logistic regression sought factors associated with a recommendation for surgery. Results A total of 186 surgeons of the Science of Variation Group completed a survey regarding recommendation of surgery for 2 different patients based on clinical scenarios. Recommendations for surgery did not vary significantly according to provider characteristics. For the various elements in scenario 1, recommendation for surgery was more likely for patients who were self-employed and continued to work and who had objective electrodiagnostic abnormalities. For the 2 vignettes used in scenario 2, a recommendation for surgery was associated with abnormal electrophysiology. Conclusions The findings of this study suggest that-at least in a survey setting-surgeons prefer to offer peripheral nerve decompression to patients with abnormal electrophysiology, particularly those with effective coping strategies. Clinical relevance The role of objective verification of pathophysiology is debated, but it is an influential factor in recommendations for hand surgery.

Original languageEnglish (US)
Pages (from-to)856-862
Number of pages7
JournalJournal of Hand Surgery
Volume38
Issue number5
DOIs
StatePublished - May 2013

Keywords

  • Carpal Tunnel Syndrome
  • Decision Making
  • Electrodiagnostic Testing
  • Peripheral Nerve
  • Surgical Treatment

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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    Hageman, M. G. H., Becker, S. J. E., Bot, A. G. J., Guitton, T., Ring, D., Wahegaonkar, A. L., GarciaG, A. E., Schefer, A., Castillo, A. P., Terrono, A. L., Gurman, A. W., Apard, T., Watkins, B., Ilyas, A., Hearon, B. F., Wills, B. P. D., Wintman, B. I., Swigart, C., Spath, C., ... Van Wyk, W. J. (2013). Variation in recommendation for surgical treatment for compressive neuropathy. Journal of Hand Surgery, 38(5), 856-862. https://doi.org/10.1016/j.jhsa.2013.02.008