Clinical Development and Medical Affairs, Pfizer Global Development Headquarters, New London, CT, USA.
BMC Musculoskelet Disord. 2011 Apr 12;12:73. doi: 10.1186/1471-2474-12-73.
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.
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.
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).
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.
掌腱膜挛缩症是一种纤维增生性疾病，影响英国人口的 3-5%。目前治疗掌腱膜挛缩症（Dupuytren 挛缩）的手术方法包括筋膜切开术和筋膜切除术。我们评估了 5 年内英格兰对掌腱膜挛缩症的临床治疗管理；对 1 年内的 NHS 相关费用进行了评估。
从 2003 年 4 月至 2008 年 3 月，提取患有掌腱膜纤维瘤（ICD10=M720）和掌腱膜挛缩相关手术的患者的医院入院记录。变量包括人口统计学、OPCS、患者状态和医生专业。为了估计 2010-2011 年的费用，应用 HRG4 代码和 2010-11-NHS 信托国家时间表对 2007-2008 年的数据进行了计算。
在 5 年内，共记录了 75157 例掌腱膜挛缩症入院病例，其中 64506 例进行了分析。每年的平均入院人数为 12901 人，且保持稳定。日间手术的比例从 42%（2003-2004 年）增加到 62%（2007-2008 年）。每年有两次或以上入院的患者比例从 2003-2004 年的 5.5%增加到 2007-2008 年的 26.1%。2003 年至 2007 年期间，91%的手术是筋膜切开术。筋膜切开术和筋膜切除术的修订分别占约 4%；截肢占 1%。2007 年，分类方法扩展到包括数字筋膜切开术、其修订和真皮筋膜切开术。2007-2008 年的入院病例为：70%的掌腱膜切开术、16%的数字筋膜切开术、1.3%的其他筋膜切开术、4.4%的掌腱膜切开术修订、1.3%的数字筋膜切开术修订、3.8%的掌腱膜切开术、2.6%的真皮筋膜切开术和 1.1%的截肢术。79%的病例由创伤和矫形外科医生管理，19%由整形外科医生管理。2003-2004 年和 2007-2008 年的住院平均（±SD）住院时间分别为 1.5（±1.4）天和 1.0（±1.3）天。1 年（2010-2011）的总估计费用为 41576141 英镑。每位患者的费用为 2885 英镑（日间手术）和 3534 英镑（住院）。费用范围从 2736 英镑（日间手术筋膜切开术）到 9210 英镑（日间手术数字修订术）。
2003 年至 2008 年间，在英格兰，筋膜切开术是治疗掌腱膜挛缩症最常见的手术方法。尽管手术率和医生专业略有不同，但手术场所发生了逆转：随着日间手术的增加，住院手术减少。这种变化可能是由于经济趋势和医疗保健系统的变化所致。2010-2011 年的估计费用因手术类型和患者状况而异。这些发现可用于了解掌腱膜挛缩症的临床治疗管理，并指导医疗保健政策。
