Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy.

Abstract

Sir: We read with great interest the article entitled “Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy”1 by Billig et al. in the November of 2018 issue of the Journal. The authors used the Truven MarketScan databases to identify gender differences in resource use before undergoing wrist arthroscopy for nontraumatic wrist pain. They also used CPT codes for identifying preoperative resource use such as imaging and occupational therapy. However, some of these codes are not specific for wrist or wrist pain and might have confound the results. For example, CPT code 73200 stands for computed tomography of the upper extremity without contrast, which includes the shoulder, scapula, and clavicle besides the wrist. CPT codes 97124 and 97810 stand for massage and acupuncture without electric stimulation, respectively. It is unclear whether the authors were able to identify whether the use of computed tomography, massage, or acupuncture was related exclusively to wrist pain instead of other sources of pain or distinguish it from a regular treatment performed by the individual patient. The same observation arises with respect to pain medication and steroid use. The inability to identify resource use related to the studied procedure would add a limitation to the study as a result of MarketScan database use. Identifying baseline use of these resources before wrist pain diagnosis will help us understand whether the differences found are related to wrist pain or to something else. We are also interested in whether the duration of symptoms, time to clinical presentation, duration of pain medication use, number of prescriptions, over-the-counter/nonprescription pain medication use, and gender differences related to these variables were able to be elucidated, because these factors might affect the conclusion that women use more pain medication compared with men. We would like to point out that gender equity in health care does not always mean the same treatment for men and women. It does not mean that women with wrist pain have to receive the same number of imaging studies or pain medication prescriptions as men. It means providing gender-equitable diagnosis and treatment and equal access to care for all genders. Research should focus on identifying these gender differences, even the ones related to disease presentation, duration and severity of symptoms, time to clinical presentation, patients’ preferences, or response to treatment. The authors did not elaborate on whether the database took into context sex assigned at birth that might be different from gender. Ultimately, understanding how gender and biological sex assigned at birth affect the disease process and response to treatment helps us provide better patient care.2 Lastly, we would like to thank the authors for opening the discussion of gender disparity. With the current limitation of the information provided by the MarketScan databases, it is not possible to ascertain the reasons for these gender disparities. Future studies that use qualitative research approaches such as questionnaires and interviews similar to the studies conducted by Hawker et al.3 and Borkhoff et al.4 will be meaningful additions to the literature on this critical topic. DISCLOSURE None of the authors has a financial interest to declare in relation to the content of this communication. Malke Asaad, M.D.Division of Plastic Surgery Krishna Vyas, M.D., Ph.D., M.H.S.Division of Plastic SurgeryMayo Clinic Margaret Akinhanmi, B.S.Department of PsychiatryMayo Clinic Graduate School of Biomedical Science Joyce E. Balls-Berry, Ph.D.Department of Health Sciences ResearchDivision of EpidemiologyMayo ClinicRochester, Minn.