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Factors Associated with Operative Treatment of Enthesopathy of the Extensor Carpi Radialis Brevis Origin
Amir Reza Kachooei, MD; Mojtaba Talaei-Khoei, MD; Aram Faghfouri, PhD; David Ring, MD, PhD
Massachusetts General Hospital, Boston, MA

Introduction: We aimed to study the factors associated with variation in the rate of surgery for enthesopathy of the extensor carpi radialis brevis (eECRB).
Methods: We used a large database from 3 hospitals including 5964 patients with diagnosis of eECRB from 2001 to 2007. Of those, 244 (4%) patients had surgery for eECRB. We used the date of the first encounter as the date of diagnosis. We also recorded the date of first injection and surgery for eECRB. Accounting for the time elapsed from diagnosis to surgery (event), we used Cox multivariable regression analysis to find factors associated with surgery for eECRB. We considered the following explanatory factors: age, sex, race, diabetes, a diagnosis of major depression, a diagnosis of an anxiety disorder, hospital, provider (surgeon vs. non-surgeon), corticosteroid injection, and the time from diagnosis to first cortisone injection.
Results: The odds of having surgery were 12 times greater if the initial provider was an orthopedic surgeon rather a non-surgeon. The odds of having surgery were 1.7 times greater at one of the two hospitals. Younger age was also associated with surgery. There was a substantial variation in the rate of surgery among providers ranging from zero to 22% with the highest and lowest rates both orthopaedic surgeons. Corticosteroid injection delayed the time to surgery, but was ultimately associated with a higher rate of surgery. The vast majority (86%) of surgeries were done within the one year of the first documented office visit for this diagnosis.
Conclusion: Given the substantial variation in surgery for eECRB by provider, methods for ensuring that patient preferences have a greater influence on decision-making (e.g. decision aids) merit additional study.

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