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. 2014 May;39(5):844-51.
doi: 10.1016/j.jhsa.2013.12.035. Epub 2014 Mar 25.

The influence of surgeon age on distal radius fracture treatment in the United States: a population-based study

Jennifer F Waljee  1 , Lin Zhong  1 , Melissa J Shauver  1 , Kevin C Chung  2
Affiliations

The influence of surgeon age on distal radius fracture treatment in the United States: a population-based study

Jennifer F Waljee et al. J Hand Surg Am. 2014 May.

Abstract

Purpose: This study attempted to determine the extent to which surgeon age influences treatment patterns for distal radius fractures (DRFs). We hypothesized that younger surgeons perform open reduction internal fixation (ORIF) for DRFs among elderly individuals more frequently than older surgeons, who employ a wider range of treatment modalities.

Methods: We identified 61,314 Medicare beneficiaries who experienced DRFs and the 12,823 surgeons who performed ORIF, external fixation, pinning, or closed reduction on them during 2007. We examined the effect of surgeon age on DRF treatment pattern, controlling for patient characteristics and other surgeon factors using multinomial logistic regression. We then stratified our analysis by American Society for Surgery of the Hand membership to more closely examine the influence of surgeon specialization on the association between surgeon age and DRF treatment.

Results: Surgeons aged 40 years and younger were more likely to perform ORIF and less likely to choose external fixation and percutaneous pinning to treat DRFs, compared with older surgeons. Surgeon specialization mitigated this relationship, and American Society for Surgery of the Hand members were more likely to choose ORIF compared with nonmembers. However, surgeon age remained a significant predictor of treatment choice after controlling for other factors and surgeon specialization.

Conclusions: Younger surgeons are more likely to perform ORIF for DRFs among Medicare beneficiaries over 65 years of age. Given the lack of evidence supporting any single treatment option for DRF, understanding the factors that drive dissemination of operative techniques may provide insight into treatment disparities within the Medicare population.

Type of study/level of evidence: Therapeutic III.

Keywords: Distal radius fractures; open reduction internal fixation; surgeon age.

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Figures

Figure 1
Figure 1
Cohort flowchart and DRF treatment in the study cohort
Figure 2
Figure 2
Adjusted rate of DRF treatment on patients by surgeon age among a cohort of Medicare beneficiaries in 2007. ¥ *: P value <0.001 ¥: The rates are calculated controlling for surgeon ASSH membership, DRF volume and patient age, gender, race, SES, comorbidity and concurrent injury.
Figure 3
Figure 3
Adjusted rate of DRF treatment on patients by surgeon age among Medicare beneficiaries in 2007, stratified by ASSH membership. ¥
See this image and copyright information in PMC

References

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    1. Chung KC, Shauver MJ, Yin H, Kim HM, et al. Variations in the use of internal fixation for distal radial fracture in the United States medicare population. J Bone Joint Surg Am. 2011;93(23):2154–2162. - PMC - PubMed
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    1. Chung KC, Shauver MJ, Yin H. The relationship between ASSH membership and the treatment of distal radius fracture in the United States Medicare population. The Journal of hand surgery. 2011;36(8):1288–1293. - PubMed
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