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Treatment Trends in Dupuytren Disease: A Large Payor Database Analysis
Andi J Cummins, MD
1; Danielle J Rogan, MS
2; Virginia J Bee, MD
2; Daniel P Donato, MD
31Univserity of Texas Medical Branch, Galveston, TX; 2University of Texas Medical Branch, GALVESTON, TX; 3University of Texas Medical Branch, Galveston, TX
Introduction: Dupuytren disease is a benign, fibroproliferative disorder of the palmar or digital fascia that may cause debilitating flexion contracture and is reported to affect up to 1% of the US population. There are multiple treatment options for Dupuytren contractures (DC), including limited fasciectomy (LF) and less invasive methods- collagenase
Clostridium histiolyticum (CCH) with delayed manipulation, and percutaneous needle aponeurotomy (PNA). However, there is no consensus on the recurrence rate, treatment duration, complications, and order of treatment. The purpose of this study is to use TriNetX, a large payor database, to delineate rates of complications, recurrence, and need for additional procedures in a large population sample.
Materials & Methods: A large-scale payor database, TriNetX, was used to analyze outcomes in DC patients who underwent CCH, PNA, LF, or a combination of these treatments. Patient factors including demographics, medical comorbidities, time to treatment, and treatment pathways were collected, and statistical analysis was performed using embedded software.
Results: Using the US Collaborative Dataset, 121,761 patients were identified as having a diagnosis of Dupuytren disease, palmar fascia contracture, or related diagnoses. See Table 1 for additional comparison of demographic and medical characteristics. Approximately 16% of patients underwent intervention for DC. Of those that chose intervention, 48% chose limited fasciectomy as initial treatment. 1.26% underwent a second fasciectomy later, possibly indicating recurrence. Roughly 30.1% underwent CCH injections as the initial treatment, of these 14.1% underwent a second treatment at an average of 18 months from initial, and 4.7% went on to fasciectomy within 2 years [Figure 1]. Approximately 10% of patients underwent PNA, there was minimal repeat intervention, and the cohort tended to have more medical comorbidities like COPD, CAD, and diabetes compared to CCH cohort.
Conclusion: There is continued controversy about the effectiveness and longevity of treatment options for DC including LF, CCH, and PNA. This large database study shows that most patients who do seek procedural treatment tend to favor less invasive options initially but may require repeat treatment or progression to surgery, and that timing of repeat intervention for less invasive treatments is less than 3 years on average.
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