title: Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England.
abstract: BACKGROUND
  Dupuytren's disease is a fibro-proliferative disorder affecting ~3-5% of the UK population. Current surgical treatments for Dupuytren's contracture (DC) include fasciectomy and fasciotomy. We assessed the clinical management of DC in England over a 5-year period; associated NHS costs were assessed for a 1-year period.
  
  
  METHODS
  Hospital Episode Statistics were extracted from April 2003 to March 2008 for patients with Palmar Fascial Fibromatosis (ICD10=M720) and DC-related procedures. Variables included demographics, OPCS, patient status and physician specialty. To estimate 2010-2011 costs, HRG4 codes and the National Schedule of Tariff 2010-11-NHS Trusts were applied to the 2007-2008 period.
  
  
  RESULTS
  Over 5 years, 75,157 DC admissions were recorded; 64,506 were analyzed. Mean admissions per year were 12,901 and stable. Day cases increased from 42% (2003-2004) to 62% (2007-2008). The percent of patients having two or more admissions per year increased from 5.5% in 2003-2004 to 26.1% in 2007-2008. Between 2003 and 2007, 91% of procedures were Fasciectomy. Revision of Fasciectomy and Fasciotomy each accounted for ~4%; Amputation for 1%. In 2007, classification was extended to identify Digital Fasciectomy, its Revision and Dermofasciectomy. In 2007-2008, admissions were: 70% Palmar Fasciectomy, 16% Digital Fasciectomy, 1.3% Other Fasciectomy, 4.4% Revision of Palmar Fasciectomy, 1.3% Revision of Digital Fasciectomy, 3.8% Division of Palmar Fascia, 2.6% Dermofasciectomy and 1.1% Amputation. 79% of cases were overseen by trauma and orthopaedic surgeons, 19% by plastic surgeons. Mean (±SD) inpatient hospital length of stay was 1.5 (±1.4) days in 2003-2004 and 1.0 (±1.3) days in 2007-2008. Total estimated costs for 1 year (2010-2011) were £41,576,141. Per-patient costs were £2,885 (day case) and £3,534 (inpatient). Costs ranged from £2,736 (day-case Fasciectomy) to £9,210 (day-case Revision Digital).
  
  
  CONCLUSIONS
  Between 2003 and 2008, fasciectomy was the most common surgical procedure for DC in England. While procedure rates and physician specialties varied little, there was a reversal in surgical venue: inpatient operations decreased as day-case procedures increased. The change is likely due to economic trends and changes to the healthcare system. Estimated costs for 2010-2011 varied by procedure type and patient status. These findings can be used to understand clinical management of DC and guide healthcare policy.
authors.affiliation: Clinical Development and Medical Affairs, Pfizer Global Development Headquarters, New London, CT, USA. robert.a.gerber@pfizer.com
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gerber
authors.forename: Richard
authors.initials: R
authors.lastname: Perry
authors.forename: Robin
authors.initials: R
authors.lastname: Thompson
authors.forename: Christopher
authors.initials: C
authors.lastname: Bainbridge
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics; D000671:Amputation, Surgical / Q000191:economics; D019992:Databases as Topic; D004387:Dupuytren Contracture / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D004739:England / Q000453:epidemiology; D000071938:Fasciotomy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D019637:Orthopedic Procedures / Q000191:economics*; D010343:Patient Admission / Q000191:economics; D012086:Reoperation; D012189:Retrospective Studies; D013222:State Medicine / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome