Additional Treatment after Collagenase Injections and Needle Fasciotomy for Dupuytren’s Disease: A Retrospective Cohort Study

Abstract

Introduction The aim of this study was to assess the rate of additional treatment after collagenase injection and needle fasciotomy, and what factors are associated with additional procedures for recurrence. Materials and Methods We retrospectively identified 201 adult patients who underwent collagenase injection and 19 patients who underwent needle fasciotomy for Dupuytren’s disease from 2012 to 2014. Outcomes included additional treatment of the same ray for either recurrence or persistence of contracture. To evaluate associated factors, we performed a bivariate analysis. Results Additional treatment after collagenase injection for recurrence was performed in 24% of fingers at a median of 23 months (interquartile range [IQR]: 10.8–36.1) and was associated with bilateral disease (p = 0.008). Additional treatment for persistence was performed in 5.6% at a median of 1.9 months (IQR: 1.1–3.2). Additional treatment for recurrence after needle fasciotomy was performed in 13% of fingers at a median of 28.2 months (IQR: 27.5–28.2) and 4.2% for persistence at 1.1 months. Fingers treated with needle fasciotomy were more likely to undergo secondary open fasciectomy (13% vs. 5.1%, p = 0.022). Conclusion Additional treatment after collagenase injections was performed in 29% of fingers, mostly another collagenase injection, and was associated with bilateral disease. After needle fasciotomy, 17% of patients underwent additional treatment, primarily open partial fasciectomy.

Comparison of Patient Demographics, Utilization Trends, and Costs of Treatment for Dupuytren’s Disease in the United States From 2012 to 2019

“…Thus, although Leafblad et al 22 demonstrated higher direct costs for fasciectomy than CCH, the cumulative costs when accounting for future reinterventions were higher for CCH than fasciectomy. Similarly, in a retrospective comparative study of collagenase injections and needle fasciotomy in 220 patients from 2012 to 2014, Arnold et al 24 found a greater need for additional treatment after CCH injections, which was primarily another CCH injection. In addition, in a model assessing cost-effectiveness using data from published studies and Medicare in a simulated cohort of 10,000 individuals with Dupuytren’s disease, Yoon et al 25 indicated that CCH injections were not preferred to fasciectomy or PNA for treating recurrent Dupuytren’s disease because of a higher incremental cost-effectiveness ratio, which is the cost in US dollars per quality-adjusted life year.…”