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 language | English |
|---|---|
| Pages (from-to) | 856-862 |
| Number of pages | 7 |
| Journal | Journal of Hand Surgery |
| Volume | 38 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2013 |
| Externally published | Yes |
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Keywords
- Carpal Tunnel Syndrome
- Decision Making
- Electrodiagnostic Testing
- Peripheral Nerve
- Surgical Treatment
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
- Surgery
Cite this
Variation in recommendation for surgical treatment for compressive neuropathy. / Hageman, Michiel G H; Becker, Stephanie J E; Bot, Arjan G J; Guitton, Thierry; Ring, David; Wahegaonkar, Abhijeet L.; GarciaG, Aida E.; Schefer, Alan; Castillo, AlbertoPérez; Terrono, Andrew L.; Gurman, Andrew W.; Apard, T.; Watkins, Barry; Ilyas, Asif; Hearon, Bernard F.; Wills, Brian P D; Wintman, Bruce I.; Swigart, Carrie; Spath, Catherine; Miranda, Cesar Dario Oliveira; Goldfarb, Charles A.; Cassidy, Charles; Metzger, Charles; Eaton, Charles; Wilson, Chris; Walsh, Christopher J.; Wilson, Christopher J.; Jones, Christopher M.; Young, Colby; Bottke, Craig A.; Osei, Daniel A.; Kirkpatrick, D. Kay; Polatsch, Daniel; Tate, David E.; Nelson, David L.; Kalainov, David M.; Lamey, David M.; Hanel, Doug; Ostrowski, David M.; Miller, David R.; McKee, Desirae M.; Ruchelsman, David; Bonatz, Ekkehard; Shin, Eon K.; Hofmeister, Eric P.; Fischer, Evan S.; Kaplan, F. Thomas D; Fernandes, C. H.; Forigua, Jamie E.; Cayon, Fidel Ernesto Cayon; Raia, Frank J.; Walter, Frank L.; Frykman, Gary K.; Pess, Gary M.; Kuzma, Gary R.; Huemer, Georg M.; Byrd, Gregory Dee; Balfour, George W.; Caro, Gladys Cecilia Zambrano; Hernandez, German Ricardo; DeSilva, Gregory; Bamberger, H. Brent; Grunwald, H. W.; MccUtchan, Hal; Solomon, Harrison; Kimball, Hervey L.; Stuart, J. E B; Lin, Ines C.; Choueka, Jack; Reid, James G.; Boler, James M.; Pomerance, Jay; Johnson, Jeff W.; Yao, Jeffrey; Calandruccio, Jim; Green, Jennifer B.; Wolf, Jennifer Moriatis; Frankenhoff, Jessica A.; Oakey, Jerome W.; Fischer, Jochen; Howlett, John; Jiuliano, John; Erickson, John M.; McAuliffe, John; Evans, John P.; Taras, John; Boretto, Jorge G.; Isaacs, Jonathan; Ortiz, Jose A.; Di Giovanni, José Fernando; Nolla, Jose; Abzug, Joshua M.; Adams, Julie; Bainbridge, L. C.; Chivers, Karel; Prommersberger, Karl Josef; Malone, Kevin J.; Lee, Kendrick; Halperin, Lawrence S.; Weiss, Lawrence; Benson, Leon; Lane, Lewis B.; Paz, Lior; Lattanza, Lisa; Palmer, M. Jason; Catalano, Louis; Richard, Marc J.; Rizzo, Marco; Boyer, Martin; Calcagni, Maurizio; Wood, Megan M.; Baskies, Michael; Grafe, Michael W.; Behrman, Michael; Jones, Michael; Quinn, Michael; Nancollas, Michael; Kessler, Michael W.; Pirela-Cruz, Miguel A.; Patel, Milan M.; Felipe, Naquira Escobar Luis; Harness, Neil G.; Akabudike, Ngozi M.; Horangic, Nicholas J.; Semenkin, Oleg M.; Leung, Nicky L.; McCulloch, Patrick T.; Owens, Patrick; Martineau, Paul A.; Bettinger, Paul; Guidera, Paul; Hoepfner, Peter E.; Sitaram, Prasad; DeNoble, Peter H.; Jebson, Peter; Coogan, Philip; Dantuluri, Phani; Gaston, R. Glenn; Nyszkiewicz, Ralf; Costanzo, Ralph M.; De Bedout, Ramon; Hauck, Randy; Fricker, Renato M.; Gilbert, Richard S.; Hutchison, Richard L.; Barth, Richard W.; Papandrea, Rick; Szabo, Robert M.; Gray, Robert R L; Nathan, Ross; Rozental; Spruijt, Sander; Shatford, Russell; Klinefelter, Ryan; Sodha, Samir; Calfee, Ryan P.; Kakar, Sanjeev; Kaplan, Saul; Duncan, Scott F.; Mitchell, Scott; Dodds, Seth; Jacoby, Sidney M.; Kennedy, Stephen A.; Marczyk, Stanley Casimir; Dailey, Stephen W.; Kronlage, Steve; Alter, Steven; Beldner, Steven; McCabe, StevenSteven J.; Hilliard, Stuart M.; Fischer, Thomas J.; Baxamusa, Taizoon; Taleb, C.; Varecka, Thomas F.; Wyrick, Theresa; Havenhill, Timothy G.; Siff, Todd; Knoll, Victoria D.; Patel, Vipul P.; Batson, W. Arnnold; Hammert, Warren C.; Van Wyk, William J.
In: Journal of Hand Surgery, Vol. 38, No. 5, 01.05.2013, p. 856-862.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Variation in recommendation for surgical treatment for compressive neuropathy
AU - Hageman, Michiel G H
AU - Becker, Stephanie J E
AU - Bot, Arjan G J
AU - Guitton, Thierry
AU - Ring, David
AU - Wahegaonkar, Abhijeet L.
AU - GarciaG, Aida E.
AU - Schefer, Alan
AU - Castillo, AlbertoPérez
AU - Terrono, Andrew L.
AU - Gurman, Andrew W.
AU - Apard, T.
AU - Watkins, Barry
AU - Ilyas, Asif
AU - Hearon, Bernard F.
AU - Wills, Brian P D
AU - Wintman, Bruce I.
AU - Swigart, Carrie
AU - Spath, Catherine
AU - Miranda, Cesar Dario Oliveira
AU - Goldfarb, Charles A.
AU - Cassidy, Charles
AU - Metzger, Charles
AU - Eaton, Charles
AU - Wilson, Chris
AU - Walsh, Christopher J.
AU - Wilson, Christopher J.
AU - Jones, Christopher M.
AU - Young, Colby
AU - Bottke, Craig A.
AU - Osei, Daniel A.
AU - Kirkpatrick, D. Kay
AU - Polatsch, Daniel
AU - Tate, David E.
AU - Nelson, David L.
AU - Kalainov, David M.
AU - Lamey, David M.
AU - Hanel, Doug
AU - Ostrowski, David M.
AU - Miller, David R.
AU - McKee, Desirae M.
AU - Ruchelsman, David
AU - Bonatz, Ekkehard
AU - Shin, Eon K.
AU - Hofmeister, Eric P.
AU - Fischer, Evan S.
AU - Kaplan, F. Thomas D
AU - Fernandes, C. H.
AU - Forigua, Jamie E.
AU - Cayon, Fidel Ernesto Cayon
AU - Raia, Frank J.
AU - Walter, Frank L.
AU - Frykman, Gary K.
AU - Pess, Gary M.
AU - Kuzma, Gary R.
AU - Huemer, Georg M.
AU - Byrd, Gregory Dee
AU - Balfour, George W.
AU - Caro, Gladys Cecilia Zambrano
AU - Hernandez, German Ricardo
AU - DeSilva, Gregory
AU - Bamberger, H. Brent
AU - Grunwald, H. W.
AU - MccUtchan, Hal
AU - Solomon, Harrison
AU - Kimball, Hervey L.
AU - Stuart, J. E B
AU - Lin, Ines C.
AU - Choueka, Jack
AU - Reid, James G.
AU - Boler, James M.
AU - Pomerance, Jay
AU - Johnson, Jeff W.
AU - Yao, Jeffrey
AU - Calandruccio, Jim
AU - Green, Jennifer B.
AU - Wolf, Jennifer Moriatis
AU - Frankenhoff, Jessica A.
AU - Oakey, Jerome W.
AU - Fischer, Jochen
AU - Howlett, John
AU - Jiuliano, John
AU - Erickson, John M.
AU - McAuliffe, John
AU - Evans, John P.
AU - Taras, John
AU - Boretto, Jorge G.
AU - Isaacs, Jonathan
AU - Ortiz, Jose A.
AU - Di Giovanni, José Fernando
AU - Nolla, Jose
AU - Abzug, Joshua M.
AU - Adams, Julie
AU - Bainbridge, L. C.
AU - Chivers, Karel
AU - Prommersberger, Karl Josef
AU - Malone, Kevin J.
AU - Lee, Kendrick
AU - Halperin, Lawrence S.
AU - Weiss, Lawrence
AU - Benson, Leon
AU - Lane, Lewis B.
AU - Paz, Lior
AU - Lattanza, Lisa
AU - Palmer, M. Jason
AU - Catalano, Louis
AU - Richard, Marc J.
AU - Rizzo, Marco
AU - Boyer, Martin
AU - Calcagni, Maurizio
AU - Wood, Megan M.
AU - Baskies, Michael
AU - Grafe, Michael W.
AU - Behrman, Michael
AU - Jones, Michael
AU - Quinn, Michael
AU - Nancollas, Michael
AU - Kessler, Michael W.
AU - Pirela-Cruz, Miguel A.
AU - Patel, Milan M.
AU - Felipe, Naquira Escobar Luis
AU - Harness, Neil G.
AU - Akabudike, Ngozi M.
AU - Horangic, Nicholas J.
AU - Semenkin, Oleg M.
AU - Leung, Nicky L.
AU - McCulloch, Patrick T.
AU - Owens, Patrick
AU - Martineau, Paul A.
AU - Bettinger, Paul
AU - Guidera, Paul
AU - Hoepfner, Peter E.
AU - Sitaram, Prasad
AU - DeNoble, Peter H.
AU - Jebson, Peter
AU - Coogan, Philip
AU - Dantuluri, Phani
AU - Gaston, R. Glenn
AU - Nyszkiewicz, Ralf
AU - Costanzo, Ralph M.
AU - De Bedout, Ramon
AU - Hauck, Randy
AU - Fricker, Renato M.
AU - Gilbert, Richard S.
AU - Hutchison, Richard L.
AU - Barth, Richard W.
AU - Papandrea, Rick
AU - Szabo, Robert M.
AU - Gray, Robert R L
AU - Nathan, Ross
AU - Rozental,
AU - Spruijt, Sander
AU - Shatford, Russell
AU - Klinefelter, Ryan
AU - Sodha, Samir
AU - Calfee, Ryan P.
AU - Kakar, Sanjeev
AU - Kaplan, Saul
AU - Duncan, Scott F.
AU - Mitchell, Scott
AU - Dodds, Seth
AU - Jacoby, Sidney M.
AU - Kennedy, Stephen A.
AU - Marczyk, Stanley Casimir
AU - Dailey, Stephen W.
AU - Kronlage, Steve
AU - Alter, Steven
AU - Beldner, Steven
AU - McCabe, StevenSteven J.
AU - Hilliard, Stuart M.
AU - Fischer, Thomas J.
AU - Baxamusa, Taizoon
AU - Taleb, C.
AU - Varecka, Thomas F.
AU - Wyrick, Theresa
AU - Havenhill, Timothy G.
AU - Siff, Todd
AU - Knoll, Victoria D.
AU - Patel, Vipul P.
AU - Batson, W. Arnnold
AU - Hammert, Warren C.
AU - Van Wyk, William J.
PY - 2013/5/1
Y1 - 2013/5/1
N2 - 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.
AB - 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.
KW - Carpal Tunnel Syndrome
KW - Decision Making
KW - Electrodiagnostic Testing
KW - Peripheral Nerve
KW - Surgical Treatment
UR - http://www.scopus.com/inward/record.url?scp=84876672776&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84876672776&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2013.02.008
DO - 10.1016/j.jhsa.2013.02.008
M3 - Article
C2 - 23561726
AN - SCOPUS:84876672776
VL - 38
SP - 856
EP - 862
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
SN - 0363-5023
IS - 5
ER -