AI Article Synopsis
- The study investigates factors influencing surgical treatment decisions for thumb carpometacarpal arthritis, noting that both patient characteristics and mental health impact reported symptoms but may not dictate treatment.
- An analysis of 1,994 patients reveals that the majority were female and white, with only 9% ultimately undergoing surgery, highlighting a significant delay from initial assessment to surgery.
- Key findings indicate that while mental health conditions like depression affect perceived pain and function, factors such as previous surgeries and surgeon attitudes are more significant in determining whether patients proceed to surgery.
Article Abstract
Purpose: The thumb carpometacarpal (CMC) joint is the second most common site of osteoarthritis in the hand, yet reported symptoms and ultimate treatment decisions are not simply a function of radiographic appearance. This study aimed to determine the patient- and/or disease-related factors associated with patients undergoing surgical treatment of thumb CMC arthritis.
Methods: This retrospective cohort study analyzed 1,994 patients with thumb CMC arthritis treated at 2 institutions between February 2015 and November 2018. Patient demographic and clinical information was obtained from medical records to characterize treatment modalities before hand surgeon evaluation, mental and physical comorbidities, and Patient-Reported Outcomes Measurement Information System assessments. After bivariate analysis, a multivariable logistic regression model evaluated factors associated with undergoing thumb CMC surgery.
Results: This cohort was predominately female (70%) and white (91%), mean age at first appointment, 62 ± 10 years. A total of 170 patients underwent surgery for thumb CMC arthritis (9%) at a median of 114 days (interquartile range, 27-328) after the first visit. Patient-Reported Outcomes Measurement Information System Depression scores correlated with Pain Interference and Physical Function scores. A history of diagnosed depression or anxiety was associated with less perceived Physical Function at presentation. However, only prior contralateral thumb CMC surgery, younger patient age, and treating institution were associated with undergoing surgery in regression modeling.
Conclusions: Pain and functional limitations associated with thumb CMC arthritis are influenced by mental health comorbidities, but these factors do not predict surgical treatment. Instead, patients' prior surgical experience and surgeon attitudes toward thumb CMC arthritis appear to have a strong influence on the odds of patients undergoing surgery for thumb CMC arthritis.
Type Of Study/level Of Evidence: Prognostic IV.
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Source |
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| http://dx.doi.org/10.1016/j.jhsa.2021.02.009 | DOI Listing |
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