Gordon Adam M, Nian Patrick P, Miller Chaim, Schwartz Jake M, Choueka Jack
From the Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY.
Ann Plast Surg. 2023 Nov 1;91(5):547-552. doi: 10.1097/SAP.0000000000003665. Epub 2023 Aug 19.
Dupuytren's disease is a fibroproliferative disorder of the palm leading to flexion deformities of the digits that impair hand function. Studies have evaluated treatment trends for patients with Dupuytren's disease; however, most conclude in 2012 shortly after collagenase clostridium histolyticum (CCH) injection was introduced to the market. It is unknown how provider preferences have been influenced since its introduction. We aimed to compare treatment options with regard to (1) patient demographics, (2) annual utilization rates, and (3) costs.
The PearlDiver nationwide administrative claims database from 2012 to 2019 was analyzed for patients diagnosed with Dupuytren's disease (N = 47,813). Patients receiving procedural treatment were identified using codes for percutaneous needle aponeurotomy (PNA) (current procedural terminology [CPT] 26040), open fasciotomy (CPT 26045), open fasciectomy (CPT 26121, 26123, 26125), and CCH injection (CPT 20527). Fasciectomies were further analyzed by examining the number of patients receiving release of 1 or more digits (CPT 26123, 26125) versus palmar-only surgery (CPT 26121). Outcomes included comparing patient comorbidities comprising the Elixhauser Comorbidity Index (ECI), frequencies of each procedure annually, and costs. Linear regressions evaluated changes in utilization over time. Analysis of variance compared costs. P values less than 0.05 were significant.
Patient demographics for each treatment differed with respect to age, sex, and the presence of multiple comorbidities comprising the ECI. Open fasciectomy (60.7%) was the predominant treatment, followed by CCH injection (22.9%), PNA (10.1%), and open fasciotomy (6.3%) ( P < 0.001). Multiple patient comorbidities comprising the ECI differed for each treatment. Relative to total annual procedures from 2012 to 2019, PNA declined (10.2% to 9.5%, P = 0.037), open fasciotomy declined (6.8% to 5.6%, P = 0.007), palmar fasciectomy remained constant (14.5% to 14.2%, P = 0.710), fasciectomy of digits increased (46.3% to 47.5%, P = 0.030), and CCH injection remained constant (22.2% to 23.3%, P = 0.623). Day of procedure costs were significantly different for PNA ($573), open fasciotomy ($1176), palmar open fasciectomy ($1410), open fasciectomy digits ($1560), and CCH injection ($1250) ( P < 0.001).
The overall annual Dupuytren's disease treatment did not change over time. Treatment with open fasciectomy continues to be preferred. Collagenase clostridium histolyticum utilization has remained constant since its introduction. This study may assist hand surgeons in educating patients on the treatment and costs related to Dupuytren's disease.
杜普伊特伦挛缩病是一种手掌部的纤维增生性疾病，可导致手指屈曲畸形，从而损害手部功能。已有研究评估了杜普伊特伦挛缩病患者的治疗趋势；然而，大多数研究在溶组织梭状芽孢杆菌胶原酶（CCH）注射剂上市后不久的2012年就结束了。自其上市以来，尚不清楚医疗服务提供者的偏好受到了怎样的影响。我们旨在比较以下方面的治疗选择：（1）患者人口统计学特征，（2）年使用率，以及（3）成本。
分析了PearlDiver 2012年至2019年的全国行政索赔数据库中被诊断为杜普伊特伦挛缩病的患者（N = 47,813）。使用经皮针状腱膜切开术（PNA）（当前操作术语[CPT] 26040）、开放性筋膜切开术（CPT 26045）、开放性筋膜切除术（CPT 26121、26123、26125）和CCH注射（CPT 20527）的编码来识别接受手术治疗的患者。通过检查接受1个或更多手指松解术（CPT 26123、26125）的患者数量与仅进行手掌手术（CPT 26121）的患者数量，对筋膜切除术进行了进一步分析。结果包括比较构成埃利克斯豪泽共病指数（ECI）的患者合并症、每年每种手术的频率以及成本。线性回归评估了使用率随时间的变化。方差分析比较了成本。P值小于0.05具有统计学意义。
每种治疗方法的患者人口统计学特征在年龄、性别以及构成ECI的多种合并症的存在方面存在差异。开放性筋膜切除术（60.7%）是主要治疗方法，其次是CCH注射（22.9%）、PNA（10.1%）和开放性筋膜切开术（6.3%）（P < 0.001）。构成ECI的多种患者合并症在每种治疗方法中各不相同。相对于2012年至2019年的年度总手术量，PNA有所下降（10.2%至9.5%，P = 0.037），开放性筋膜切开术有所下降（6.8%至5.6%，P = 0.007），手掌筋膜切除术保持不变（14.5%至14.2%，P = 0.710），手指筋膜切除术增加（46.3%至47.5%，P = 0.030），CCH注射保持不变（22.2%至23.3%，P = 0.623）。PNA（573美元）、开放性筋膜切开术（1176美元）、手掌开放性筋膜切除术（1410美元）、手指开放性筋膜切除术（1560美元）和CCH注射（1250美元）的手术当日成本存在显著差异（P < 0.001）。
杜普伊特伦挛缩病的总体年度治疗随时间未发生变化。开放性筋膜切除术仍是首选治疗方法。自溶组织梭状芽孢杆菌胶原酶上市以来，其使用率一直保持不变。本研究可能有助于手外科医生就杜普伊特伦挛缩病的治疗及相关成本对患者进行教育。
