National Utilization Patterns of XXXX Injection and Operative Intervention for Treatment of Common Hand Conditions.

@entity1 @entity57251 @entity923 @entity1795 @entity479
PURPOSE: To conduct a population-level analysis of practice trends and probability of surgery based on the number of @entity479 injections for common hand conditions. METHODS: @entity1 aged at least 18 years receiving injection or surgery for @entity923 ( @entity923 ), @entity1795 ( @entity1795 ), or de Quervain @entity57251 (DQ) were identified for inclusion using the 2009 to 2013 Truven MarketScan databases. The researchers counted the number of injections performed and calculated the time between injection and operation for @entity1 receiving both treatments. A multivariable logistic regression model was created to evaluate the odds of undergoing surgery based on the number of injections performed, controlling for @entity1 age, sex, comorbidities, and insurance type. RESULTS: The study sample included 251,030 @entity1 who underwent @entity479 injection or operative release for @entity923 (n  = 129,917), @entity1795 (n  = 102,778), and DQ (n  = 18,335). Most @entity1 with @entity923 were managed with immediate surgery (71%), whereas most @entity1 with @entity1795 and DQ were managed initially with injection (74% and 84%, respectively). Among @entity1 receiving both an injection and an operation, a single injection was the  most common practice before surgery (69%, 58%, and 67% of @entity1 with @entity923 , @entity1795 , and DQ, respectively). Multiple injections for DQ and @entity1795 were associated with relatively low predicted probability of surgery (17% and 26%, respectively, after 2 injections). However, the predicted probability of surgery after 2 injections was higher in @entity1 with @entity923 (44%). CONCLUSIONS: Given the associated probability of surgery after multiple injections for the 3 hand conditions examined, the practice of repeat injections should be critically examined to determine whether underuse or overuse is present and whether efficiency and use of resources can be improved upon. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
