Surgical treatment of Dupuytren's disease - outcome and health economy in relation to smoking and diabetes.
BACKGROUND
The conventional treatment for Dupuytren's disease is surgery. The introduction of alternative treatment strategies creates a need to track outcomes and costs relating to surgical treatment and risk factors, such as smoking and diabetes. This was the aim of the present study.


METHODS
In a prospective study, the outcome of open surgical treatment for finger flexion contracture in Dupuytren's disease (175 patients; 182 surgical procedures) was studied by evaluating valid QuickDASH forms answered by subjects before surgery and one year postoperatively. Data were also obtained from medical records, and preoperative declarations concerning health.


RESULTS
In all subjects (median [25% - 75% percentiles] age 68 [62-73]), the QuickDASH score improved from 22 [9-36] to 5 [0-18]. Smokers (27/179 procedures) were younger and had a more severe degree of disease and dysfunction preoperatively than non-smokers, but the outcome of surgery did not differ between the groups. Subjects with diabetes (20/181 procedures) were younger than those without diabetes, but their disease severity or outcome did not differ. Hand specialists operated faster than residents, but the surgical outcome did not differ. Healthcare costs for surgery for Dupuytren's contracture were $ 2392 (€ 1859), which were not higher among smokers or subjects with diabetes. Only 22 patients remained in hospital (2 [1-2.3] days) and 28 patients needed sick leave (28 [21-31] days). The occurrence of necrosis of skin flaps (12%) or infections (6%) was no more frequent among smokers or those with diabetes.


CONCLUSIONS
There is no difference in surgical outcome for finger flexion contracture in Dupuytren's disease between smokers and non-smokers or between subjects with or without diabetes, although smokers had more severe preoperative contracture. The costs for surgical treatment for finger flexion contracture in Dupuytren's disease should be viewed in relation to that for other treatment strategies.
David
D
Eckerdal
Axel
A
Nivestam
Department of Clinical Sciences Malmö - Hand Surgery, Lund University and Skåne University Hospital, Malmö, Sweden. lars.dahlin@med.lu.se.
Lars B
LB
Dahlin
D017677:Age Distribution; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004387:Dupuytren Contracture / Q000191:economics / Q000453:epidemiology / Q000451:nursing / Q000534:rehabilitation / Q000601:surgery*; D000071938:Fasciotomy; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D009819:Office Visits / Q000191:economics; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D018582:Sick Leave / Q000191:economics; D012907:Smoking / Q000453:epidemiology; D013043:Specialties, Surgical; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome