Hand surgery volume and the US economy: is there a statistical correlation?
BACKGROUND
To the best of our knowledge, there have been no previous studies evaluating the correlation of the US economy and hand surgery volume. Therefore, in light of the current recession, our objective was to study our institution's hand surgery volume over the last 17 years in relation to the nation's economy.


METHODS
A retrospective analysis of our institution's hand surgery volume, as represented by our most common procedure (ie, carpal tunnel release), was performed between January 1992 and October 2008. Liposuction and breast augmentation volumes were chosen to serve as cosmetic plastic surgery comparison groups. Pearson correlation statistics were used to estimate the relationship between the surgical volume and the US economy, as represented by the 3 market indices (Dow Jones, NASDAQ, and S&P500).


RESULTS
A combined total of 7884 hand surgery carpal tunnel release (open or endoscopic) patients were identified. There were 1927 (24%) and 5957 (76%) patients within the departments of plastic and orthopedic surgery, respectively. In the plastic surgery department, there was a strong negative (ie, inverse relationship) correlation between hand surgery volume and the economy (P < 0.001). In converse, the orthopedic department's hand surgery volume demonstrated a positive (ie, parallel) correlation (P < 0.001). The volumes of liposuction and breast augmentation also showed a positive correlation (P < 0.001).


CONCLUSIONS
To our knowledge, we have demonstrated for the first time an inverse (ie, negative) correlation between hand surgery volumes performed by plastic surgeons in relation to the US economy, as represented by the 3 major market indices. In contrast, orthopedic hand surgery volume and cosmetic surgery show a parallel (ie, positive) correlation. This data suggests that plastic surgeons are increasing their cosmetic surgery-to-reconstructive/hand surgery ratio during strong economic times and vice versa during times of economic slowdown.
Gordon
Chad R
CR
Department of Plastic, Cleveland Clinic, Cleveland, OH, USA. gordonc@ccf.org
Pryor
Landon
L
Afifi
Ahmed M
AM
Gatherwright
James R
JR
Evans
Peter J
PJ
Hendrickson
Mark
M
Bernard
Steven
S
Zins
James E
JE
D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000191:economics / Q000706:statistics & numerical data*; D004467:Economics; D005260:Female; D006225:Hand / Q000601:surgery; D005102:Health Expenditures; D006801:Humans; D015994:Incidence; D008297:Male; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D013518:Surgery, Plastic / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States; D016526:Workload