Current trends in the surgical management of Dupuytren s disease in Europe: an analysis of patient charts

Transcription

1 Current trends in the surgical management of Dupuytren s disease in Europe: an analysis of patient charts Chris Bainbridge 1, Lars B. Dahlin 2, Piotr P. Szczypa 3, Joseph C. Cappelleri 4, Daniel Guerin 5, Robert A. Gerber 4 1 Pulvertaft Hand Centre, Derby, Derbyshire, UK 2 Skåne University Hospital, Malmö, Lund University, Sweden 3 Pfizer Ltd., Surrey, UK, 4 Pfizer Inc, New London, CT, USA 5 A+A Healthcare Research, Lyon, France

2 Introduction Source: Phototake Dupuytren s disease (DD) typically affects older men of northern European descent1 Overall prevalence is approximately 13%2 Intervention usually involves surgery3 In this study, orthopedic, plastic, and hand surgeons reviewed charts of patients they treated for Dupuytren s contracture (DC) 1. Hindocha S, et al. Hand. 2009;4: Attali P, et al. Arch Intern Med. 1987;147: Townley WA, et al. BMJ. 2006;332:

3 Methods Patients treated surgically for DC were identified Orthopedic, plastic, and hand surgeons reviewed medical charts of 5 consecutive patients they treated between September and December 2008 Surgeons were recruited from 12 European countries Czech Republic, Denmark, Finland, France, Germany, Hungary, Italy, Netherlands, Poland, Spain, Sweden, and United Kingdom 3

4 Patient cases reviewed Country Patient cases reviewed Surgeon respondents Total Orthopedic Plastic Hand* UK Germany France Italy Spain Hungary Czech Republic Poland Netherlands Sweden Denmark Finland Total * Hand surgeons were a subgroup of orthopedic and plastic surgeons. 4

5 Patient characteristics at diagnosis 81% of patients were men Mean age of patients was 62 years (SD, 10.2) 37% of patients were more than 65 years old 11% were less than 50 years old In 49% of cases, DD had been diagnosed by a general practitioner 88% of patients had 1 hand affected by DD 38% of patients had 1 finger affected 41% had 2 fingers affected 21% had 3 or more fingers affected Surgeons reported that DD limited function in leisure activities for 56% of patients Limited function in work activities for 57% SD, standard deviation. 5

6 Tubiana stage at time of procedure Nodules only Stage Ia (0-20 )* Stage Ib (21-45 ) Stage II (46-90 ) Stage III ( ) Stage IV (>135 ) *Degrees indicate total flexion contracture, as illustrated. 6

7 Procedures performed Proportion of patients receiving each procedure* (n=3357) *Total of percentages exceeds 100% because each patient could receive multiple procedures. Number of fingers operated closely reflected number affected 41% had 1 finger operated 43% had 2 fingers operated 16% had 3 fingers operated Procedures involved MCP joints in 80% of fingers operated PIP joints in 66% DIP joints in 20% Mean number of joints operated was 2.9 (SD, 1.9) As would be expected, more aggressive procedures were performed for patients at higher Tubiana stages DIP, distal interphalangeal; MCP, metacarpophalangeal; PIP, proximal interphalangeal; SD, standard deviation. 7

8 Hospitalization patterns Patients, % *Operated in-hospital as outpatient/day case. Patients were more likely to be admitted as inpatients for more aggressive procedures 8

9 Safety and conclusions SAFETY Rate of reported complications during procedure was 4% overall 11% in patients undergoing dermofasciectomy Most common post-operative complications reported were hematoma (8% of patients), wound healing complications (6%), pain (7%) No post-operative complications were reported in 77% of patients CONCLUSIONS This study is the first to provide data on surgical management of several thousand Dupuytren s patients across Europe Fasciectomy was the most common surgical procedure performed More invasive procedures, often requiring inpatient admission, were performed in patients with more severe disease 9

10 Disclosures Chris Bainbridge has received support/funding from Pfizer Inc. Lars B. Dahlin has received support/funding from Pfizer Inc. Piotr P. Szczypa, Joseph C. Cappelleri, and Robert A. Gerber are study investigators for and employees of Pfizer Inc. Daniel Guerin, PharmD, is Prescription Analysis Department Director at A+A Healthcare Research Study was sponsored by Pfizer Inc. Statistical analyses were provided by A+A Healthcare Research and funded by Pfizer Inc. Medical writing support was provided by Lisa Baker, PhD, of UBC Scientific Solutions and funded by Pfizer Inc. 10