Thayer Mary Kate, Somerson Jeremy S, Huang Jerry I
Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Wash.
Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Tex.
Plast Reconstr Surg Glob Open. 2018 Oct 3;6(10):e1932. doi: 10.1097/GOX.0000000000001932. eCollection 2018 Oct.
Collagenase Clostridium histolyticum (CCH) injection has been shown to be a safe and effective treatment option for Dupuytren's contracture. We hypothesize that the gaining popularity of CCH has resulted in a change in treatment patterns among providers, with increased utilization of CCH injections in the management of Dupuytren's contracture from 2012 to 2014.
The Medicare Provider Utilization and Payment Data Public Use Files were used to identify all surgeons who submitted claims for surgical fasciectomy, needle aponeurotomy (NA), and CCH injection. The data were analyzed for number of providers performing the procedures, number of procedures per provider, and location of practice.
From 2012 to 2014, the number of providers performing more than 10 open fasciectomies decreased from 141 to 131. In the same time, the number of providers performing more than 10 NAs increased from 63 to 70 with mean procedures per provider decreasing from 35 to 21. In contrast, the number of providers performing more than 10 CCH injections increased from 72 to 112, with mean injections per provider going from 24 to 20. The total number of injections performed increased from 1,734 to 2,220 from 2012 to 2014. The largest increase in number of injections and number of providers performing injections occurred in the South.
The introduction of collagenase has changed treatment patterns with more providers treating Dupuytren's contractures with CCH injections and a statistically significant decline in the number of NA procedures per provider.
已证明注射溶组织梭状芽孢杆菌胶原酶（CCH）是治疗掌腱膜挛缩症的一种安全有效的方法。我们推测，CCH日益普及导致医疗服务提供者的治疗模式发生了变化，2012年至2014年期间，在掌腱膜挛缩症的治疗中，CCH注射的使用有所增加。
利用医疗保险提供者利用和支付数据公共使用文件，确定所有提交手术筋膜切除术、针状腱膜切开术（NA）和CCH注射索赔的外科医生。分析了执行这些手术的提供者数量、每个提供者的手术数量以及执业地点的数据。
2012年至2014年期间，进行超过10次开放性筋膜切除术的提供者数量从141人减少到131人。与此同时，进行超过10次NA手术的提供者数量从63人增加到70人，每个提供者的平均手术数量从35次减少到21次。相比之下，进行超过10次CCH注射的提供者数量从72人增加到112人，每个提供者的平均注射次数从24次减少到20次。2012年至2014年期间，注射的总数从1734次增加到2220次。注射数量和进行注射的提供者数量增加最多的地区是南部。
胶原酶的引入改变了治疗模式，更多的医疗服务提供者使用CCH注射治疗掌腱膜挛缩症，且每个提供者的NA手术数量出现了具有统计学意义的下降。
