title: Dupuytren's disease presentation, referral pathways and resource utilisation in Europe: regional analysis of a surgeon survey and patient chart review.
abstract: OBJECTIVE
  We explored the management of Dupuytren's disease (DD) using a surgeon survey and patient chart review.
  
  
  METHODS
  Twelve countries participated: Denmark, Finland, Sweden (Nordic region); Czech Republic, Hungary, Poland (East); France, Germany, the Netherlands, United Kingdom (West); Italy, Spain (Mediterranean). A random sample of orthopaedic/plastic surgeons (N = 687) with 3-30 years' experience was asked about Dupuytren's contracture procedures performed during the previous 12 months. Information ≤ 5 consecutive patients per surgeon was extracted from patient charts (N = 3357).
  
  
  RESULTS
  Overall, 84% of participants were orthopaedic surgeons; 56% of surgeons were hand specialists. Deciding factors for fasciectomy and dermofasciectomy were consistent across regions: metacarpophalangeal (MP) or proximal interphalangeal contracture > 45°, recurrent contracture, and high expectations for success. Deciding factors for percutaneous needle fasciotomy were less consistent across regions, but the leading factor was MP flexion < 20°. Overall, 49% of diagnoses and 55% of referrals were made by a general practitioner (GP), with regional variation: 31-77% for GP diagnoses and 36-81% for GP referrals. There were also differences in admission status (e.g. 9% of Nordic patients and 80% of Eastern patients were treated as inpatients). Most patients were treated in public hospitals and most procedures were covered by public health insurance.
  
  
  CONCLUSIONS
  We found regional variations in surgical practice, patient characteristics and referral patterns. Understanding current diagnosis and treatment patterns, in relation to regional differences in health economics, may improve physicians' diagnosis of DD and guide patients towards appropriate, customised management plans.
authors: Department of Clinical Sciences - Hand Surgery, Lund University, Skåne University Hospital Malmö, Malmö, Sweden. lars.dahlin@med.lu.se
authors: L B
authors: LB
authors: Dahlin
authors: C
authors: C
authors: Bainbridge
authors: C
authors: C
authors: Leclercq
authors: R A
authors: RA
authors: Gerber
authors: D
authors: D
authors: Guerin
authors: J C
authors: JC
authors: Cappelleri
authors: P P
authors: PP
authors: Szczypa
authors: J
authors: J
authors: Dias
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004387:Dupuytren Contracture / Q000601:surgery*; D005060:Europe; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013518:Surgery, Plastic / Q000706:statistics & numerical data; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014850:Waiting Lists