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Dupuytren's disease presentation, referral pathways and resource utilisation in Europe: regional analysis of a surgeon survey and patient chart review

Authors


  • Disclosures

    Drs Bainbridge, Dahlin, Dias, and Leclercq have received support/funding from Pfizer Inc. J. C. Cappelleri and R. A. Gerber are employees and stockholders of Pfizer Inc; P. P. Szczypa is an employee and stockholder of Pfizer Ltd. D. Guerin is an employee of A+A Healthcare Marketing Research, who was a paid consultant to Pfizer Inc for this study.

Correspondence to:

Lars B. Dahlin,

Department of Clinical Sciences – Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, SE-205 02 Malmö, Sweden

Tel.: +46 40 336769

Fax: +46 40 928855

Email: lars.dahlin@med.lu.se

Summary

Aim

We explored the management of Dupuytren's disease (DD) using a surgeon survey and patient chart review.

Methods

Twelve countries participated: Denmark, Finland, Sweden (Nordic region); Czech Republic, Hungary, Poland (East); France, Germany, the Netherlands, United Kingdom (West); Italy, Spain (Mediterranean). A random sample of orthopaedic/plastic surgeons (N = 687) with 3–30 years' experience was asked about Dupuytren's contracture procedures performed during the previous 12 months. Information ≤ 5 consecutive patients per surgeon was extracted from patient charts (N = 3357).

Results

Overall, 84% of participants were orthopaedic surgeons; 56% of surgeons were hand specialists. Deciding factors for fasciectomy and dermofasciectomy were consistent across regions: metacarpophalangeal (MP) or proximal interphalangeal contracture > 45°, recurrent contracture, and high expectations for success. Deciding factors for percutaneous needle fasciotomy were less consistent across regions, but the leading factor was MP flexion < 20°. Overall, 49% of diagnoses and 55% of referrals were made by a general practitioner (GP), with regional variation: 31–77% for GP diagnoses and 36–81% for GP referrals. There were also differences in admission status (e.g. 9% of Nordic patients and 80% of Eastern patients were treated as inpatients). Most patients were treated in public hospitals and most procedures were covered by public health insurance.

Conclusions

We found regional variations in surgical practice, patient characteristics and referral patterns. Understanding current diagnosis and treatment patterns, in relation to regional differences in health economics, may improve physicians' diagnosis of DD and guide patients towards appropriate, customised management plans.

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