Journal Article

Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England

Thompson, Robin, Gerber, Robert A, Perry, Richard, Bainbridge, Christopher

2011

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Ambulatory Surgical Procedures - economics / Amputation / Amputation - economics / Analysis / Care and treatment / Codes / Databases as Topic / Demography / Diagnosis / Disease management / Dupuytren Contracture - diagnosis / Dupuytren Contracture - economics / Dupuytren Contracture - epidemiology / Dupuytren Contracture - surgery / Dupuytren's contracture / England - epidemiology / Epidemiology / Epidemiology of musculoskeletal disorders / Fascia / Fasciotomy / Female / Hand surgery / Health aspects / Health Care Costs / Health services / Hospital costs / Humans / Internal Medicine / Length of Stay - economics / Male / Medical care, Cost of / Medicine / Medicine & Public Health / Middle Aged / Models, Economic / Musculoskeletal diseases / Orthopedic Procedures - economics / Orthopedics / Patient Admission - economics / Patient admissions / Plastics / Primary care / Rehabilitation / Reoperation / Research Article / Retrospective Studies / Rheumatology / Sports Medicine / State Medicine - economics / Statistical analysis / Surgery / Tariffs / Time Factors / Trauma / Treatment Outcome / Trends