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Predictors of Satisfaction with Hand Function In Patients Undergoing Limited Fasciectomy for Dupuytren's Disease
Chao Zhou, MD1; Ranjit Singh, MSc1; Michiel Zuidam, MD1; Xander Smit, MD1; Harm Slijper, PhD2; Reinier Feitz, MD2; Steven Hovius, MD, PhD1; Ruud Selles, PhD1

Plastic, Reconstructive and Hand surgery, Erasmus Medical Center and Xpert Clinic, Rotterdam, Netherlands; 2Hand and Wrist Surgery, Xpert Clinic, Hilversum, Netherlands

Introduction: Knowledge of the determinants of satisfaction in patients with Dupuytren's disease may offer unique perspectives on the definition of therapeutic success. This study investigated which demographical variables, disease-characteristics, and functional outcomes predicted satisfaction with hand function in patients undergoing Limited Fasciectomy (LF) for Dupuytren's contracture.

Methods: In this multicenter prospective study, 23 patients undergoing LF completed the Michigan Hand Questionnaire (MHQ) at baseline and at varying time points in the first year after surgery. We derived satisfaction with hand function subscores, ranging from 0(completely dissatisfied) to 100(completely satisfied), from the most recently completed questionnaires. These scores were used to dichotomize patients into a satisfied and dissatisfied category according to a previously published anchoring method. Baseline characteristics and functional outcomes assessed at the first follow-up time point were considered as possible predictors. Uni- and multivariable regression modeling was used to identify independent predictors of satisfaction. Receiver-operating curves assessed the discriminative ability of the model.

Results: At an average of 10 months (range, 6-12) postoperatively, 65% (N=153) of patients were satisfied with their hand function. Univariable analysis suggested that satisfied patients were more likely to be males, have milder PIP joint contractures and better self-reported hand function at baseline, and less residual joint contracture and better self-reported hand function after surgery. Clinically relevant factors that were not associated with satisfaction included the number of digits treated, whether the dominant side was treated or whether LF was a primary or revision procedure
(Table 1).
After multivariable analysis, baseline self-reported overall hand function (p=0.024) and postoperative residual joint contracture (p=0.001) and hand appearance (p<0.001) remained as the only independent predictors, contributing to a model able to explain 75% of the variation in satisfaction response and distinguish satisfied from dissatisfied patients (Fig. 1).

Conclusion: Less residual joint contracture and better self-reported hand appearance after treatment predicted satisfaction with hand function in patients undergoing LF for Dupuytren's contracture.

As residual joint contracture is a modifiable predictor, this study highlights the importance of achieving complete contracture reductions at which LF might be more effective than its less-invasive alternatives.

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