The Epidemiology of Surgical Intervention for Dupuytren Contracture in England

Fig. 2.1

The rate of surgery for Dupuytren contracture in the 143 NHS hospitals in England. The figure shows the different rates per 100,000 population, not standardised for age or gender. The rate varies remarkably, and there is no clear geographic pattern to suggest different disease burden in different parts of England (This figure is produced in Tableau used with permission from Academic Programs, Tableau Software)

We do know that there is a difference in disease prevalence in different countries. The disease is commoner, and possibly patients have greater diathesis (Hindocha et al. 2006) in Northern and Western European countries than in Mediterranean countries (Hindocha et al. 2009). It is thought to be rarer in oriental and African populations (Mitra and Goldstein 1994; Slattery 2010). The geography and disease prevalence do not explain the variation (Birkmeyer et al. 2013; McCulloch et al. 2013) in England with neighbouring units only 25 miles apart having very different rates.

This rate of surgery is very much smaller than the rate of prevalence (0.6–31.6 %) (Lanting et al. 2014) but higher than the incidence (34.3/100,000 men) reported in 2004 (Khan et al. 2004).

2.3 Procedures Done for Dupuytren Contracture and Variation

The commonest procedures for Dupuytren contracture recorded in England (Fig. 2.2) are “fasciectomy”, which can be either palmar or digital, with “dermofasciectomy” being quite uncommon.

Fig. 2.2

The rate/100,000 in the 143 Hospitals in the NHS in England. The different colours represent different operations for Dupuytren contracture. There is an 8 times difference in the rate of surgery between NHS hospital units in England using the method described in the Atlas of Variation (Figure reprinted from Warwick (2015))

Figure 2.2 shows the variation of the rate of intervention in the NHS hospitals studied. There is 8 variation rate using the technique described by the Department of Health in the UK (2011). Only 6.8 % had fasciotomy with 45 % having palmar surgery and 37 % having digital surgery. Revision surgery accounted for only 2.8 % of our cases. Dermofasciectomy rate of around 4 % is very small, and it probably reflects surgeon preference rather than evidence.

In England around 17,000 operations for Dupuytren contracture are done each year which cost £61 million per year or €81 million per year. If this data is extrapolated to the 28 European Union countries in 2014 with a population of 507,416,607, we would have 159,854 cases needing treatment for Dupuytren contracture, and if the costs were similar to those in the UK, the annual cost of treatment for Dupuytren contracture in Europe would be €758 million.

A European survey of 687 surgeons established that “fasciectomy” was the commonest procedure with 95 % of surgeons preferring this. A review of 3,357 patient records showed that 90 % of operations were done in patients over 50 years of age (Dias et al. 2013).

There is no change in the revision surgery rate in England. The rate of revision Dupuytren contracture surgery is steady at 2.8 %; it is much less than the expected recurrence of Dupuytren contracture rate in the literature.

Conflict of Interest Statement

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