Surgical treatment of Dupuytren’s disease – outcome and health economy in relation to smoking and diabetes

Abstract

BackgroundThe 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.MethodsIn 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.ResultsIn 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.ConclusionsThere 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.

Predictors of Outcomes Following Fasciectomy for Dupuytren’s Disease in Diabetic and Non-Diabetic Patients

“…With regards to smoking status, while Eckerdal et al 4) found no difference in surgical outcomes between smokers and non-smokers with Dupuytren's disease, smoking was found to be associated with poorer outcomes in our study. Consequently, patients who smoke should be appropriately counseled about their higher risk for a less favorable outcome, and perhaps should be advised to pursue pre-operative smoking cessation to mitigate this modifiable risk factor in order to potentially improve their outcomes.…”

“…4) This study, however, was limited in its generalizability as it only assessed outcomes based upon QuickDASH scores alone. According to Degreef and De Smet,5) no correlation of self-reported disease recurrence is seen with DM.…”

Outcome of simple decompression of the compressed ulnar nerve at the elbow – influence of smoking, gender, and electrophysiological findings

“…23 points; [10]), but at a similar level as after partial fasciectomy due to Dupuytren´s contracture (i.e. 11 points; [18]). QuickDASH is used at the hospital as a routine to evaluate outcome after different conditions since it is an accepted outcome instrument after simple decompression in the present condition [6].…”

A post hoc analysis of Dupuytren contracture treated with collagenase Clostridium histolyticum across disease stages

“…The prevalence varies between populations and age groups and the disease is more common among men and in people of Northern European descent [1][2][3]. The disease is heterogeneous involving both genetic and environmental factors [4,5]. The onset and progression varies and occasionally other fibroproliferative conditions, such as Peyronie disease (OMIM 171000) and plantar fibromatosis (or Ledderhose disease), are associated with Dupuytren contracture.…”

“…Although there is no curative treatment for Dupuytren disease, there are several treatment options of which limited fasciectomy (LF) is the most frequently used and considered the gold standard for treatment [5][6][7]. Disadvantages of this procedure are the risk of surgical complications [8] and the long postoperative recovery period [9].…”