Variation in Recommendation for Surgical Treatment for Compressive Neuropathy

Hageman, Michiel G.H.; Becker, Stéphanie; Bot, Arjan G.J.; Guitton, Thierry G.; Ring, David; Wahegaonkar, Abhijeet L.; GarciaG, Aida E.; Schefer, Alan; Castillo, Alberto Pérez; Terrono, Andrew L.; Gurman, Andrew W.; Apard, Thomas; Watkins, Barry; Ilyas, Asif M.; Hearon, Bernard F.; Wills, Brian P.D.; Wintman, Bruce I.; Swigart, Carrie R.; 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, Dan; Polatsch, Daniel B.; Tate, David E.; Nelson, David L.; Kalainov, David M.; Lamey, David M.; Hanel, Doug; Ostrowski, David M.; Miller, David; McKee, Desirae M.; Ruchelsman, David E.; Bonatz, Ekkehard; Shin, Eon K.; Hofmeister, Eric P.; Fischer, Evan S.; Kaplan, F. Thomas D.; Fernandes, Carlos Henrique; Forigua, Jamie E.; Cayón, Fidel; Raia, Frank J.; Walter, Frank L.; Frykman, Gary K.; Pess, Gary M.; Kuzma, Gary R.; Huemer, Georg M.; Byrd, Gregory D.; Balfour, George W; Zambrano, Gladys Cecilia; Hernández, Germán; DeSilva, Gregory L.; Bamberger, H. Brent; Grünwald, Hans; McCutchan, Hal; Solomon, Harrison B.; Kimball, Hervey L.; Stuart, J. E.B.; Lin, Ines C.; Choueka, Jack; Reid, James; Boler, James M.; Pomerance, Jay; Johnson, Jeff W.; Yao, Jeffrey; Calandruccio, Jim; Green, Jennifer B.; Wolf, Jennifer Moriatis; Frankenhoff, J.; Oakey, Jerome W.; Fischer, Jochen; Howlett, John; Jiuliano, John; Erickson, John M.; McAuliffe, John A.; Evans, John; Taras, John S.; Boretto, Jorge G.; Isaacs, Jonathan; Ortíz, José Alfredo Soto; Giovanni, Jose Fernando Di; Nolla, Jose; Abzug, Joshua M.; Adams, Julie E.; Bainbridge, L. C.; Chivers, Karel; Prommersberger, K.-J.; Malone, Kevin J.; Lee, Kendrick; Halperin, Lawrence S.; Weiss, Lawrence; Benson, Leon S.; Lane, Lewis B.; Paz, Lior; Lattanza, Lisa; Palmer, M. Jason; Catalano, Louis W.; Richard, Marc J.; Rizzo, Marco; Boyer, Martin I.; Calcagni, Maurizio; Wood, Megan M.; Baskies, Michael A.; Grafe, Michael; Behrman, Michael; Jones, Michael; Quinn, Michael T.; 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 W.; Martineau, Paul A.; Bettinger, Paul C.; Guidera, Paul M.; Hoepfner, Peter E.; Sitaram, Prasad; DeNoble, Peter H.; Jebson, Peter J.L.; Coogan, Philip S.; Dantuluri, Phani K.; Gaston, R. Glenn; Nyszkiewicz, R.; Costanzo, Ralph M.; Bedout, R. de; Hauck, Randy M.; Fricker, R.; Gilbert, Richard S.; Hutchison, Richard L.; Barth, Richard W.; Papandrea, Rick F.; Szabo, Robert M.; Gray, Robert R.L.; Nathan, Ross; Rozental,; Spruijt, S.; Shatford, Russell A.; Klinefelter, Ryan; Sodha, Samir; Calfee, Ryan P.; Kakar, Sanjeev; Kaplan, Saul J.; Duncan, Scott F. M.; Mitchell, Scott G.; Dodds, Seth D.; Jacoby, Sidney M.; Kennedy, Stephen A.; Marczyk, Stanley Casimir; Dailey, Stephen W.; Kronlage, Steve; Alter, Steven; Beldner, Steven; McCabe, Steven; Hilliard, Stuart M.; Fischer, Thomas J.; Baxamusa, Taizoon; Taleb, C.; Varecka, Thomas F.; Wyrick, Theresa; Havenhill, Timothy G.; Siff, Todd E.; Knoll, Victoria D.; Patel, Vipul P.; Batson, W. Arnnold; Hammert, Warren C.; Wyk, William J. Van

doi:10.1016/j.jhsa.2013.02.008

Cited by 5 publications

(8 citation statements)

References 9 publications

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“…Another limitation is that the data were obtained from fictional patient scenarios. 4,19,20 We designed straightforward scenarios for the studied conditions, but the recommendations offered might be different with actual patients. Finally, 24% of the SOVG members responded, as described in the methods, which does not represent an actual response rate.…”

Section: Discussionmentioning

confidence: 99%

“…22 Variation in testing and treatment is common for upper extremity conditions, in part because most tests and treatments are discretionary and highly preference sensitive. [1][2][3][4][5][6][7] This variation in surgeon recommendations is a sign of nonstandardized treatment. A short summary of preferred practice before giving treatment recommendations affected recommendations for surgery.…”

Section: Discussionmentioning

confidence: 99%

“…I n orthopaedic surgery, as in other medical fields, there is unexplained surgeon-to-surgeon variation in recommendations for tests and treatments. [1][2][3][4][5][6][7] The existing literature can be confusing: surgical treatments are studied more often than nonsurgical treatments, studies with positive results are more commonly reported than studies that report no difference or negative results, and conditions that are infrequent or difficult to treat are overrepresented. Variations in recommendations of nonsurgical treatment in upper extremity conditions remain unclear, especially when evidence is inconclusive and treatment recommendations are preference sensitive.…”

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confidence: 99%

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Variation in Nonsurgical Treatment Recommendations for Common Upper Extremity Conditions

Johanna

Wilkens

Ring

et al. 2019

J Am Acad Orthop Surg

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Background: In orthopaedic surgery, there is known surgeon-tosurgeon 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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Variation in Nonsurgical Treatment Recommendations for Common Upper Extremity Conditions

Johanna

Wilkens

Ring

et al. 2019

J Am Acad Orthop Surg

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“…Second, prior studies with similar "fictitious" case scenario survey designs only incorporated 5 to 6 factors. 12,13 The number of patient factors in our case scenarios may have interfered with surgical decision making. As a result, most factors-except age and angulation-seem to have comparable influence on treatment recommendations.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with a Recommendation for Operative Treatment for Fracture of the Distal Radius

et al. 2021

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Background Evidence suggests that there is substantial and unexplained surgeon-to-surgeon variation in recommendation of operative treatment for fractures of the distal radius. We studied (1) what factors are associated with recommendation for operative treatment of a fracture of the distal radius and (2) which factors are rated as the most influential on recommendation of operative treatment. Methods One-hundred thirty-one upper extremity and fracture surgeons evaluated 20 fictitious patient scenarios with randomly assigned factors (e.g., personal, clinical, and radiologic factors) for patients with a fracture of the distal radius. They addressed the following questions: (1) Do you recommend operative treatment for this patient (yes/no)? We determined the influence of each factor on this recommendation using random forest algorithms. Also, participants rated the influence of each factor—excluding age and sex— on a scale from 0 (not at all important) to 10 (extremely important). Results Random forest algorithms determined that age and angulation were having the most influence on recommendation for operative treatment of a fracture of the distal radius. Angulation on the lateral radiograph and presence or absence of lunate subluxation were rated as having the greatest influence and smoking status and stress levels the lowest influence on advice to patients. Conclusions The observation that—other than age—personal factors have limited influence on surgeon recommendations for surgery may reflect how surgeon cognitive biases, personal preferences, different perspectives, and incentives may contribute to variations in care. Future research can determine whether decision aids—those that use patient-specific probabilities based on predictive analytics in particular—might help match patient treatment choices to what matters most to them, in part by helping to neutralize the influence of common misconceptions as well as surgeon bias and incentives. Level of Evidence There is no level of evidence for the study.

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“…29,37 We compared staging systems and subgroups using the Z test, as previously described by our group. 5,6,11,12,[14][15][16][17][18]32,40,42,45 Results Participants Twenty-six of the 32 observers supervised surgical trainees, and 62% were in practice 6 years or more. Demographics of the observers are reported in Table I.…”

Section: Discussionmentioning

confidence: 99%

Osteochondritis dissecans of the humeral capitellum: reliability of four classification systems using radiographs and computed tomography

Claessen

Ende

Doornberg

et al. 2015

Journal of Shoulder and Elbow Surgery

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Variation in Recommendation for Surgical Treatment for Compressive Neuropathy

Cited by 5 publications

References 9 publications

Variation in Nonsurgical Treatment Recommendations for Common Upper Extremity Conditions

Variation in Nonsurgical Treatment Recommendations for Common Upper Extremity Conditions

Factors Associated with a Recommendation for Operative Treatment for Fracture of the Distal Radius

Osteochondritis dissecans of the humeral capitellum: reliability of four classification systems using radiographs and computed tomography

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