Factors Associated with Operative Treatment of De Quervain Tendinopathy

Background:  Geographic and doctor-to-doctor variations in care are a focus of quality and safety efforts in medicine. This study addresses factors associated with variation in the rate of operative treatment of de Quervain tendinopathy.   Methods: We used a database including all patient encounters at ۲ large medical centers, to study the experience of ۱۰ hand surgeons and ۱ physiatrist working in a hand surgery office in the treatment of ۲,۵۱۳ patients with de Quervain tendinopathy over a ۱۲-year period. Survival analysis using the Kaplan-Meier method was used to compare surgery rates and time to surgery. Cox multivariable regression analysis was applied to identify factors associated with operative treatment. Results:  One hundred ninety nine (۷.۹%) patients had surgery. The odds of operative treatment were ۱.۷ times greater after corticosteroid injection and varied more than ۱۰-fold among providers. There was substantial variation in the overall rate of surgery by provider. Corticosteroid injection delayed surgery slightly, but was associated with a higher rate of surgery.  Conclusion:  Providers have substantial influence on treatment of de Quervain tendinopathy. The use of decision aids and other methods that help involve the patient in decision-making merit investigation as interventions to help reduce doctor-to-doctor variation.

کلیدواژه ها:

Cortisone injection ، De Quervain tendinopathy ، Decision aid ، Operative treatment ، Variation