title: National Utilization Patterns of Steroid Injection and Operative Intervention for Treatment of Common Hand Conditions.
abstract: OBJECTIVE
  To conduct a population-level analysis of practice trends and probability of surgery based on the number of steroid injections for common hand conditions.
  
  
  METHODS
  Patients aged at least 18 years receiving injection or surgery for carpal tunnel syndrome (CTS), trigger finger (TF), or de Quervain tenovaginitis (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 patients 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 patient age, sex, comorbidities, and insurance type.
  
  
  RESULTS
  The study sample included 251,030 patients who underwent steroid injection or operative release for CTS (n = 129,917), TF (n = 102,778), and DQ (n = 18,335). Most patients with CTS were managed with immediate surgery (71%), whereas most patients with TF and DQ were managed initially with injection (74% and 84%, respectively). Among patients receiving both an injection and an operation, a single injection was the most common practice before surgery (69%, 58%, and 67% of patients with CTS, TF, and DQ, respectively). Multiple injections for DQ and TF 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 patients with CTS (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.
  
  
  METHODS
  Prognostic II.
authors.affiliation: Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI. Electronic address: endavis@med.umich.edu.
authors.forename: Erika D
authors.initials: ED
authors.lastname: Sears
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Swiatek
authors.affiliation: Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D053684:De Quervain Disease / Q000188:drug therapy* / Q000601:surgery*; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D052582:Trigger Finger Disorder / Q000188:drug therapy* / Q000601:surgery*; D014481:United States
chemical_list: D013256:Steroids
keywords: Steroid injection; carpal tunnel syndrome; de Quervain tenovaginitis; treatment utilization; trigger finger