Dondapati Akhil, Tran Janet Ngoc, Zaronias Callista, Fowler Cody C, Carroll Thomas J, Mahmood Bilal
Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY.
University of Rochester Medical School. Rochester, NY.
J Hand Surg Glob Online. 2024 Sep 26;6(6):894-897. doi: 10.1016/j.jhsg.2024.08.019. eCollection 2024 Nov.
The purpose of this study was to establish the impact of area deprivation index (ADI) on treatment timelines of patients with cubital tunnel syndrome (CuTS). We hypothesize that increased social deprivation will correlate with increased time between care milestones from presentation to surgery.
This is a retrospective study of patients diagnosed with CuTS who underwent surgical intervention at a single academic institution. Variables including age, sex, body mass index, ADI, electrodiagnostic (EDX) severity classification, and time elapsed between treatment milestones were obtained. Treatment milestones included time elapsed between initial presentation to hand surgery and EDX studies, and surgery. Analysis included univariate χ tests and analysis of variance, as well as multivariate linear and logistic regressions.
Six hundred and fifty-three patients were divided by ADI national percentiles from the least to most deprived tertiles. Univariate analysis found no differences in care timelines across ADI tertiles. Multivariate analysis revealed a nonsignificant trend toward higher ADI predicting longer time from presentation to surgery. Moderate EDX rating correlated with increased time from presentation to surgery. Mild EDX ratings correlate with increased time from EDX studies to surgery. Age was a significant predictor of decreased time between initial presentation and surgery and between EDX and surgery. Completion of EDX studies prior to presentation significantly decreased time to surgery.
Social deprivation does not significantly correlate with delays in the treatment timeline for CuTS. Increased age was significantly correlated with shorter treatment timelines, which may reflect differences in physicians' approaches to patients of different ages. Electrodiagnostic testing obtained prior to initial presentation expedited care following presentation to hand clinic. However, this could reflect either an overall delay in care (if EDX were obtained because of a delay from referral to presentation) or truly expedited care.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
本研究旨在确定地区贫困指数（ADI）对肘管综合征（CuTS）患者治疗时间线的影响。我们假设社会贫困程度增加将与从就诊到手术的护理里程碑之间的时间增加相关。
这是一项对在单一学术机构接受手术干预的CuTS诊断患者的回顾性研究。获取了包括年龄、性别、体重指数、ADI、电诊断（EDX）严重程度分类以及治疗里程碑之间经过的时间等变量。治疗里程碑包括从初次就诊到手外科和EDX检查以及手术之间经过的时间。分析包括单变量χ检验和方差分析，以及多变量线性和逻辑回归。
653名患者按ADI全国百分位数分为从最不贫困到最贫困的三个三分位数。单变量分析发现各ADI三分位数之间的护理时间线无差异。多变量分析显示，ADI越高预测从就诊到手术的时间越长，但这种趋势不显著。中度EDX评级与从就诊到手术的时间增加相关。轻度EDX评级与从EDX检查到手术的时间增加相关。年龄是初次就诊与手术之间以及EDX与手术之间时间减少的显著预测因素。就诊前完成EDX检查显著缩短了手术时间。
社会贫困与CuTS治疗时间线的延迟无显著相关性。年龄增加与较短的治疗时间线显著相关，这可能反映了医生对不同年龄段患者的治疗方法差异。初次就诊前进行的电诊断测试加快了就诊到手诊科后的护理。然而，这可能反映了护理的总体延迟（如果因为从转诊到就诊的延迟而进行EDX检查）或者真正加快了护理。
研究类型/证据水平：预后II级。
