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American Association for Hand Surgery

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Social Disparities in the Management of Trigger Finger: An Analysis of 31,411 Cases
Peter G Brodeur, MA1, Devan D Patel, MD1, Jeremy E Raducha, MD1, Kang Whoo Kim, BS1, Cameron W Johnson, BS1, Elliot Rebello, BS1, Aristides I Cruz, Jr., MD, MBA1 and Joseph A Gil, MD2, (1)Alpert Medical School of Brown University, Providence, RI, (2)Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI

Introduction:
When conservative modalities are not effective, trigger finger (TF) can be effectively treated with surgical release. Cost and compliance are two factors that can significantly affect the outcomes of non-operative and operative treatment options and both may be influenced by social factors. The purpose of this study was to investigate socioeconomic disparities in the surgical treatment for TF.
Materials & Methods:
Adult patients were identified using International Classification of Diseases 9 and 10 Clinical Modification diagnostic codes for TF and Current Procedural Terminology codes (CPT: 26055) in the New York Statewide Planning and Research Cooperative System database. Each diagnosis was linked to procedure data to determine which patients went on to have TF release. A multivariable logistic regression was performed to assess the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, ethnicity, social deprivation (SDI), Charlson Comorbidity Index (CCI), and primary insurance type.
Results:
Of the 31,411 TF patients analyzed, 8,941 (28.5%) underwent surgery. Regression analysis showed higher odds of receiving surgery in females (OR: 1.1, p=0.0009) and those with workers compensation compared to private insurance (OR: 1.71, p<.0001). Older patients had lower odds of surgery (OR: 0.993, p<.0001). The odds of undergoing surgery for Asian (OR: 0.445, p<.0001), African American (OR: 0.508, p<.0001), and Other race (OR: 0.532, p<.0001) were lower relative to White patients. Medicaid (OR: 0.766, p<.0001), Medicare (OR: 0.847, p<.0001), and self-pay (OR: 0.512, p<.0001) reimbursement methods had reduced odds of receiving surgery compared to private insurance. Higher social deprivation was associated with decreased odds of surgery (OR: 0.988, p<.0001).
Conclusions:
TF release is associated with disparities among race, ethnicity, sex, primary insurance, and social deprivation. If these patients do not have proper access to surgical treatment when indicated, their TF may cause continued pain and loss of productivity as well as progress to a sustained interphalangeal joint contracture, potentially resulting in a reduced ability to work and/or decreased quality of life.



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