Factors Associated With a Discretionary Upper-Extremity Surgery

J Hand Surg Am. 2019 Feb;44(2):155.e1-155.e7. doi: 10.1016/j.jhsa.2018.04.028. Epub 2018 Jun 13.


Purpose: Surgery for nontraumatic upper-extremity problems is largely discretionary and preference-sensitive. Psychological and social determinants of health correlate with greater symptoms and limitations and might be associated with discretionary operative treatment.

Methods: We used routinely collected patient-reported outcome measures from patients with de Quervain tendinopathy, ganglion cyst, trapeziometacarpal arthritis, trigger digit, and carpal tunnel syndrome to study factors associated with discretionary surgery using multiple logistic regression. Patients completed a measure of the magnitude of physical limitations (Patient-Reported Outcomes Measurement Information System [PROMIS] Physical Function Computerized Adaptive Test [CAT]), a measure of the degree to which a person limits activities owing to pain (PROMIS Pain Interference CAT), and a measure of symptoms of depression (PROMIS Depression CAT) at every office visit.

Results: Higher PROMIS Pain Interference score, diagnoses of carpal tunnel syndrome, and treatment by teams 3, 4, or 5 were independently associated with discretionary operative treatment.

Conclusions: People with a greater tendency to limit activity owing to pain are more likely to choose discretionary surgery.

Clinical relevance: Interventions that help people remain active despite pain by addressing the psychological and social determinants of health might affect the rate of discretionary surgery.

Keywords: Coping strategies; depression; hand surgery; physical limitations.

MeSH terms

  • Arthritis / surgery
  • Carpal Tunnel Syndrome / surgery
  • Carpometacarpal Joints / surgery
  • De Quervain Disease / surgery
  • Disability Evaluation
  • Elective Surgical Procedures*
  • Female
  • Ganglion Cysts / surgery
  • Humans
  • Male
  • Middle Aged
  • Pain / complications
  • Patient Acceptance of Health Care*
  • Patient Reported Outcome Measures
  • Trigger Finger Disorder / surgery
  • Wrist / surgery