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 Miranda; Charles 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

doi:10.1016/j.jhsa.2013.02.008

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

Orthopedic Surgery

Research output: Contribution to journal › Article › peer-review

4 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 language	English (US)
Pages (from-to)	856-862
Number of pages	7
Journal	Journal of Hand Surgery
Volume	38
Issue number	5
DOIs	https://doi.org/10.1016/j.jhsa.2013.02.008
State	Published - May 2013

Keywords

Carpal Tunnel Syndrome
Decision Making
Electrodiagnostic Testing
Peripheral Nerve
Surgical Treatment

ASJC Scopus subject areas

Surgery
Orthopedics and Sports Medicine

Access to Document

10.1016/j.jhsa.2013.02.008

Cite this

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

Hageman, MGH, Becker, SJE, Bot, AGJ, Guitton, T, Ring, D, Wahegaonkar, AL, GarciaG, AE, Schefer, A, Castillo, AP, Terrono, AL, Gurman, AW, Apard, T, Watkins, B, Ilyas, A, Hearon, BF, Wills, BPD, Wintman, BI, Swigart, C, Spath, C, Miranda, CDO, Goldfarb, CA, Cassidy, C, Metzger, C, Eaton, C, Wilson, C, Walsh, CJ, Wilson, CJ, Jones, CM, Young, C, Bottke, CA, Osei, DA, Kirkpatrick, DK, Polatsch, D, Tate, DE, Nelson, DL, Kalainov, DM, Lamey, DM, Hanel, D, Ostrowski, DM, Miller, DR, McKee, DM, Ruchelsman, D, Bonatz, E, Shin, EK, Hofmeister, EP, Fischer, ES, Kaplan, FTD, Fernandes, CH, Forigua, JE, Cayon, FEC, Raia, FJ, Walter, FL, Frykman, GK, Pess, GM, Kuzma, GR, Huemer, GM, Byrd, GD, Balfour, GW, Caro, GCZ, Hernandez, GR, DeSilva, G, Bamberger, HB, Grunwald, HW, MccUtchan, H, Solomon, H, Kimball, HL, Stuart, JEB, Lin, IC, Choueka, J, Reid, JG, Boler, JM, Pomerance, J, Johnson, JW, Yao, J, Calandruccio, J, Green, JB, Wolf, JM, Frankenhoff, JA, Oakey, JW, Fischer, J, Howlett, J, Jiuliano, J, Erickson, JM, McAuliffe, J, Evans, JP, Taras, J, Boretto, JG, Isaacs, J, Ortiz, JA, Di Giovanni, JF, Nolla, J, Abzug, JM, Adams, J, Bainbridge, LC, Chivers, K, Prommersberger, KJ, Malone, KJ, Lee, K, Halperin, LS, Weiss, L, Benson, L, Lane, LB, Paz, L, Lattanza, L, Palmer, MJ, Catalano, L, Richard, MJ, Rizzo, M, Boyer, M, Calcagni, M, Wood, MM, Baskies, M, Grafe, MW, Behrman, M, Jones, M, Quinn, M, Nancollas, M, Kessler, MW, Pirela-Cruz, MA, Patel, MM, Felipe, NEL, Harness, NG, Akabudike, NM, Horangic, NJ, Semenkin, OM, Leung, NL, McCulloch, PT, Owens, PW, Martineau, PA, Bettinger, P, Guidera, P, Hoepfner, PE, Sitaram, P, DeNoble, PH, Jebson, P, Coogan, P, Dantuluri, P, Gaston, RG, Nyszkiewicz, R, Costanzo, RM, De Bedout, R, Hauck, R, Fricker, RM, Gilbert, RS, Hutchison, RL, Barth, RW, Papandrea, R, Szabo, RM, Gray, RRL, Nathan, R, Rozental, Spruijt, S, Shatford, R, Klinefelter, R, Sodha, S, Calfee, RP, Kakar, S, Kaplan, S, Duncan, SF, Mitchell, S, Dodds, S, Jacoby, SM, Kennedy, SA, Marczyk, SC, Dailey, SW, Kronlage, S, Alter, S, Beldner, S, McCabe, SSJ, Hilliard, SM, Fischer, TJ, Baxamusa, T, Taleb, C, Varecka, TF, Wyrick, T, Havenhill, TG, Siff, T, Knoll, VD, Patel, VP, Batson, WA, Hammert, WC & Van Wyk, WJ 2013, 'Variation in recommendation for surgical treatment for compressive neuropathy', Journal of Hand Surgery, vol. 38, no. 5, pp. 856-862. https://doi.org/10.1016/j.jhsa.2013.02.008

@article{3f8fe652d32040b0bdee65eb180b3d6f,

title = "Variation in recommendation for surgical treatment for compressive neuropathy",

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.",

keywords = "Carpal Tunnel Syndrome, Decision Making, Electrodiagnostic Testing, Peripheral Nerve, Surgical Treatment",

author = "Hageman, {Michiel G.H.} and Becker, {Stephanie J.E.} and Bot, {Arjan G.J.} and Thierry Guitton and David Ring and Wahegaonkar, {Abhijeet L.} and GarciaG, {Aida E.} and Alan Schefer and Castillo, {Alberto P{\'e}rez} and Terrono, {Andrew L.} and Gurman, {Andrew W.} and T. Apard and Barry Watkins and Asif Ilyas and Hearon, {Bernard F.} and Wills, {Brian P.D.} and Wintman, {Bruce I.} and Carrie Swigart and Catherine Spath and Miranda, {Cesar Dario Oliveira} and Goldfarb, {Charles A.} and Charles Cassidy and Charles Metzger and Charles Eaton and Chris Wilson and Walsh, {Christopher J.} and Wilson, {Christopher J.} and Jones, {Christopher M.} and Colby Young and Bottke, {Craig A.} and Osei, {Daniel A.} and Kirkpatrick, {D. Kay} and Daniel Polatsch and Tate, {David E.} and Nelson, {David L.} and Kalainov, {David M.} and Lamey, {David M.} and Doug Hanel and Ostrowski, {David M.} and Miller, {David R.} and McKee, {Desirae M.} and David Ruchelsman and Ekkehard Bonatz and Shin, {Eon K.} and Hofmeister, {Eric P.} and Fischer, {Evan S.} and Kaplan, {F. Thomas D.} and Fernandes, {C. H.} and Forigua, {Jamie E.} and Cayon, {Fidel Ernesto Cayon} and Raia, {Frank J.} and Walter, {Frank L.} and Frykman, {Gary K.} and Pess, {Gary M.} and Kuzma, {Gary R.} and Huemer, {Georg M.} and Byrd, {Gregory Dee} and Balfour, {George W.} and Caro, {Gladys Cecilia Zambrano} and Hernandez, {German Ricardo} and Gregory DeSilva and Bamberger, {H. Brent} and Grunwald, {H. W.} and Hal MccUtchan and Harrison Solomon and Kimball, {Hervey L.} and Stuart, {J. E.B.} and Lin, {Ines C.} and Jack Choueka and Reid, {James G.} and Boler, {James M.} and Jay Pomerance and Johnson, {Jeff W.} and Jeffrey Yao and Jim Calandruccio and Green, {Jennifer B.} and Wolf, {Jennifer Moriatis} and Frankenhoff, {Jessica A.} and Oakey, {Jerome W.} and Jochen Fischer and John Howlett and John Jiuliano and Erickson, {John M.} and John McAuliffe and Evans, {John P.} and John Taras and Boretto, {Jorge G.} and Jonathan Isaacs and Ortiz, {Jose A.} and {Di Giovanni}, {Jos{\'e} Fernando} and Jose Nolla and Abzug, {Joshua M.} and Julie Adams and Bainbridge, {L. C.} and Karel Chivers and Prommersberger, {Karl Josef} and Malone, {Kevin J.} and Kendrick Lee and Halperin, {Lawrence S.} and Lawrence Weiss and Leon Benson and Lane, {Lewis B.} and Lior Paz and Lisa Lattanza and Palmer, {M. Jason} and Louis Catalano and Richard, {Marc J.} and Marco Rizzo and Martin Boyer and Maurizio Calcagni and Wood, {Megan M.} and Michael Baskies and Grafe, {Michael W.} and Michael Behrman and Michael Jones and Michael Quinn and Michael Nancollas and Kessler, {Michael W.} and Pirela-Cruz, {Miguel A.} and Patel, {Milan M.} and Felipe, {Naquira Escobar Luis} and Harness, {Neil G.} and Akabudike, {Ngozi M.} and Horangic, {Nicholas J.} and Semenkin, {Oleg M.} and Leung, {Nicky L.} and McCulloch, {Patrick T.} and Owens, {Patrick W.} and Martineau, {Paul A.} and Paul Bettinger and Paul Guidera and Hoepfner, {Peter E.} and Prasad Sitaram and DeNoble, {Peter H.} and Peter Jebson and Philip Coogan and Phani Dantuluri and Gaston, {R. Glenn} and Ralf Nyszkiewicz and Costanzo, {Ralph M.} and {De Bedout}, Ramon and Randy Hauck and Fricker, {Renato M.} and Gilbert, {Richard S.} and Hutchison, {Richard L.} and Barth, {Richard W.} and Rick Papandrea and Szabo, {Robert M.} and Gray, {Robert R.L.} and Ross Nathan and Rozental and Sander Spruijt and Russell Shatford and Ryan Klinefelter and Samir Sodha and Calfee, {Ryan P.} and Sanjeev Kakar and Saul Kaplan and Duncan, {Scott F.} and Scott Mitchell and Seth Dodds and Jacoby, {Sidney M.} and Kennedy, {Stephen A.} and Marczyk, {Stanley Casimir} and Dailey, {Stephen W.} and Steve Kronlage and Steven Alter and Steven Beldner and McCabe, {Steven Steven J.} and Hilliard, {Stuart M.} and Fischer, {Thomas J.} and Taizoon Baxamusa and C. Taleb and Varecka, {Thomas F.} and Theresa Wyrick and Havenhill, {Timothy G.} and Todd Siff and Knoll, {Victoria D.} and Patel, {Vipul P.} and Batson, {W. Arnnold} and Hammert, {Warren C.} and {Van Wyk}, {William J.}",

year = "2013",

month = may,

doi = "10.1016/j.jhsa.2013.02.008",

language = "English (US)",

volume = "38",

pages = "856--862",

journal = "Journal of Hand Surgery",

issn = "0363-5023",

publisher = "W.B. Saunders Ltd",

number = "5",

}

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, Alberto Pérez

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 W.

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, Steven Steven 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

Y1 - 2013/5

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

SN - 0363-5023

VL - 38

SP - 856

EP - 862

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

IS - 5

ER -

Variation in recommendation for surgical treatment for compressive neuropathy

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this