Notable surgeon-to-surgeon variation in rates of uncommon surgery can reflect appropriate concentration of expertise with technically difficult or risky procedures that address problematic impairment due to objective pathophysiology. Examples include vascularized tissue transfer or transplantation to address complex tissue loss and release of bony elbow ankylosis. Perhaps more problematic is notable variation in straightforward, discretionary surgeries intended to alleviate pain, offered in the absence of objectively measurable pathophysiology, and without experimental evidence of benefit over placebo and other nonspecific effects. Evidence of concentration of this type of surgery in the hands of a few surgeons might point to inordinate influence of surgeon opinions on patient behavior. A study of variation in operations for upper extremity peripheral mononeuropathy has the potential to uncover potentially problematic variation. There are billing codes specific to common surgeries that can benefit patients with objectively verifiable neuropathies. And there are billing codes that represent less common nerve decompression surgeries that in many cases are offered in the absence of both objective evidence of pathophysiology as well as experimental evidence that surgery alleviates pain better than simulated surgery.

中文翻译：

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少数外科医生执行大部分不常见的神经减压手术。


外科医生之间不常见手术发生率的显着差异可以反映专业知识的适当集中，这些手术具有技术难度或风险，可以解决由于客观病理生理学造成的问题性损伤。例子包括血管化组织转移或移植，以解决复杂的组织损失和骨性肘关节强直的松解。也许更成问题的是，旨在减轻疼痛的直接、随意的手术存在显着差异，这些手术是在缺乏客观可测量的病理生理学的情况下进行的，并且没有实验证据表明优于安慰剂和其他非特异性效果。这种类型的手术集中在少数外科医生手中的证据可能表明外科医生的意见对患者行为的过度影响。对上肢周围单神经病手术变异的研究有可能发现潜在的有问题的变异。有针对常见手术的特定计费代码，可以使患有客观可验证的神经病的患者受益。还有一些计费代码代表不太常见的神经减压手术，在许多情况下，这些手术是在缺乏病理生理学客观证据以及手术比模拟手术更好地减轻疼痛的实验证据的情况下提供的。