title: Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014.
abstract: Background:Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014.Methods:The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014.Results:Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased (P< .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures.Conclusions:CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Lipman
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Samuel Evan
authors.initials: SE
authors.lastname: Carstensen
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Dylan Nicole
authors.initials: DN
authors.lastname: Deal
mesh_terms: D000367:Age Factors; D004387:Dupuytren Contracture / Q000628:therapy*; D000071938:Fasciotomy / Q000379:methods / Q000639:trends; D006801:Humans; D015552:Injections, Intralesional; D003012:Microbial Collagenase / Q000008:administration & dosage / Q000627:therapeutic use; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000639:trends; D019637:Orthopedic Procedures / Q000379:methods / Q000639:trends*; D014481:United States
chemical_list: D003012:Microbial Collagenase
keywords: Dupuytren disease; aponeurotomy; collagenase clostridium histolyticum; disease; fasciectomy; fasciotomy; fibroproliferative