title: Factors associated with operative treatment of enthesopathy of the extensor carpi radialis brevis origin.
abstract: BACKGROUND
  This study investigated the factors associated with variation in the rate of surgery for enthesopathy of the extensor carpi radialis brevis (eECRB).
  
  
  METHODS
  We used a large database from 3 academic hospitals including 5964 patients with the diagnosis of eECRB from 2001 to 2007. Of those, 244 patients (4%) had surgery for eECRB. We used the date of the first encounter as the date of diagnosis. We also recorded the date of the first cortisone injection and surgery for eECRB. We used Cox multivariable regression analysis to find factors associated with surgery. We considered the following explanatory factors: age, sex, race, diabetes, a diagnosis of major depression, a diagnosis of an anxiety disorder, hospital, provider (surgeon vs. nonsurgeon), corticosteroid injection, and the time from diagnosis to the first cortisone injection.
  
  
  RESULTS
  The hazard ratio of having surgery was 12-times greater if the initial provider was an orthopedic surgeon rather a nonsurgeon and 1.7-times greater at 1 of the 2 hospitals. The rate of surgery varied substantially, ranging from 0% to 22%. Corticosteroid injection delayed the time to surgery but was ultimately associated with a higher rate of surgery. The majority (86%) of surgeries were done within 1 year of the first documented office visit.
  
  
  CONCLUSIONS
  It seems likely that an emphasis on the preferences and values of the patient rather than the surgeon would decrease the variation in surgery rates for eECRB observed in this study. Methods for optimizing the influence of patient preferences and values on decision making (eg, decision aids) merit additional study.
authors.affiliation: Orthopedic Hand and Upper Extremity Department, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Amir Reza
authors.initials: AR
authors.lastname: Kachooei
authors.affiliation: Orthopedic Hand and Upper Extremity Department, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Talaei-Khoei
authors.affiliation: Orthopedic Hand and Upper Extremity Department, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: Aram
authors.initials: A
authors.lastname: Faghfouri
authors.affiliation: Orthopedic Hand and Upper Extremity Department, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Comprehensive Care Dell Medical School University of Texas, Austin, TX, USA. Electronic address: david.ring@austin.utexas.edu.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D057240:Patient Preference; D011379:Prognosis; D012189:Retrospective Studies; D013716:Tennis Elbow / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
keywords: Extensor carpi radialis brevis; corticosteroid injections; enthesopathy; lateral epicondylitis; tennis elbow; variation