Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture

Abstract

Background: One of the most feared complications following treatment of Dupuytren contracture is complex regional pain syndrome (CRPS). This study aims to provide a national perspective on the incidence of CRPS following treatment of Dupuytren contracture and identify patient factors to target for risk reduction. Methods: Using the Truven MarketScan databases from 2007 to 2016, individuals aged ≥18 years who developed CRPS within 1 year of treatment of Dupuytren contracture were identified using the International Classification of Disease diagnosis code for CRPS. Predictor variables included: age, sex, employment status, region, type of procedure, and concurrent carpal tunnel surgery. Multivariable logistic regression was used to analyze outcomes. Results: In all, 48 327 patients received treatment for Dupuytren contracture, including collagenase injection (13.6%); percutaneous palmar fasciotomy (10.3%); open palmar fasciotomy (3.9%); palmar fasciectomy with 0 (10.8%), 1 (29.2%), or multiple (19.6%) digit releases; or a combination of these procedures (12.8%). One hundred forty-five patients (0.31%) were diagnosed with CRPS at a mean of 3.4 months (standard deviation, 2.3) following treatment. Significant predictors of CRPS included female sex (odds ratio [OR], 2.02; P < .001), Southern region (OR, 1.80; P = .022), long-term disability status (OR, 4.73; P = .035), palmar fasciectomy with release of 1 (OR, 5.91; P = .003) or >1 digit (OR, 13.32; P < .001), or multiple concurrent procedures for Dupuytren contracture (OR, 8.23; P = .001). Conclusions: Based on national commercial claims data, there is a lower incidence of CRPS following treatment of Dupuytren contracture than previously reported. Risk factors identified should help with preoperative counseling and assist clinicians in targeting risk reduction measures.

Complex Regional Pain Syndrome: A Comprehensive Review

“…A similar more recent study noted a 0.64% incidence of CRPS after 172,194 patients receiving surgical treatment for distal radius fractures [ 3 ]. CRPS had previously been reported as a common complication of Dupuytren contracture, but a very recent analysis of a nationwide database found the overall incidence to be 0.31% [ 17 ].…”

Análise dos procedimentos cirúrgicos no antebraço e na mão e sua relação com a síndrome da dor regional complexa: Um estudo transversal

“…Por outro lado, Rochlin et al 11 constataram que há um maior risco de desenvolver SDRC em casos de incisões extensas ou quando são realizadas incisões em múltiplos dedos da mão; entretanto, eles não identificaram a relação específica entre a realização simultânea de fasciotomia e de descompressão do túnel do carpo descrita por Buller et al, 10 e ainda complementaram acrescentando que a incidência não se altera nem mesmo quando os procedimentos são realizados por via aberta ou endoscópica. 10,11 Neste estudo, observamos que pacientes submetidos a múltiplas incisões no antebraço e na mão (7,6%) têm 3 vezes mais chances de desenvolver a SDRC, o que reforça os achados da literatura sobre o aumento das complicações de dor complexa nesse contexto. 10,11 Para Jo et al, 5 as fraturas expostas ou com instabilidade significativa tendem a estar mais associadas ao desenvolvimento de SDRC.…”

Patients With Preexisting Anxiety and Mood Disorders Are More Likely to Develop Complex Regional Pain Syndrome After Fractures

“…In short, we trust that the diagnoses made over time reflect the observations of clinicians in our database. Similarly, multiple studies have also used ICD codes to identify patients with CRPS [8, 15, 21].…”

“…The outcome of interest was the diagnosis of CRPS I (referred to as CRPS) made by clinicians, identified using direct diagnostic codes (Supplemental Table 4; http://links.lww.com/CORR/B268). This method of using International Classification of Diseases, Tenth Edition, codes to identify patients with a diagnosis of CRPS has been described in similar high-powered studies [8, 15, 21]. Because of the controversy surrounding the etiology and pathophysiology of CRPS, as well as the variability in how it may present from patient to patient, we believe that using diagnoses by treating physicians is the best method [16].…”

“…In short, we trust that the diagnoses made over time reflect the observations of clinicians in our database. Similarly, multiple studies have also used ICD codes to identify patients with CRPS [8,15,21]. Still, the rates of misdiagnosis of AMDs are concerning, and overall detection rates can be low, which may limit our ability to accurately identify all affected patients [7,27].…”