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BMC Musculoskeletal Disorders

, 12:73

Epidemiology of musculoskeletal disorders

Abstract

BackgroundDupuytren-s disease is a fibro-proliferative disorder affecting ~3-5% of the UK population. Current surgical treatments for Dupuytren-s contracture DC include fasciectomy and fasciotomy. We assessed the clinical management of DC in England over a 5-year period; associated NHS costs were assessed for a 1-year period.

MethodsHospital Episode Statistics were extracted from April 2003 to March 2008 for patients with Palmar Fascial Fibromatosis ICD10 = M720 and DC-related procedures. Variables included demographics, OPCS, patient status and physician specialty. To estimate 2010-2011 costs, HRG4 codes and the National Schedule of Tariff 2010-11-NHS Trusts were applied to the 2007-2008 period.

ResultsOver 5 years, 75,157 DC admissions were recorded; 64,506 were analyzed. Mean admissions per year were 12,901 and stable. Day cases increased from 42% 2003-2004 to 62% 2007-2008. The percent of patients having two or more admissions per year increased from 5.5% in 2003-2004 to 26.1% in 2007-2008. Between 2003 and 2007, 91% of procedures were Fasciectomy. Revision of Fasciectomy and Fasciotomy each accounted for ~4%; Amputation for 1%. In 2007, classification was extended to identify Digital Fasciectomy, its Revision and Dermofasciectomy. In 2007-2008, admissions were: 70% Palmar Fasciectomy, 16% Digital Fasciectomy, 1.3% Other Fasciectomy, 4.4% Revision of Palmar Fasciectomy, 1.3% Revision of Digital Fasciectomy, 3.8% Division of Palmar Fascia, 2.6% Dermofasciectomy and 1.1% Amputation. 79% of cases were overseen by trauma and orthopaedic surgeons, 19% by plastic surgeons. Mean ±SD inpatient hospital length of stay was 1.5 ±1.4 days in 2003-2004 and 1.0 ±1.3 days in 2007-2008. Total estimated costs for 1 year 2010-2011 were £41,576,141. Per-patient costs were £2,885 day case and £3,534 inpatient. Costs ranged from £2,736 day-case Fasciectomy to £9,210 day-case Revision Digital.

ConclusionsBetween 2003 and 2008, fasciectomy was the most common surgical procedure for DC in England. While procedure rates and physician specialties varied little, there was a reversal in surgical venue: inpatient operations decreased as day-case procedures increased. The change is likely due to economic trends and changes to the healthcare system. Estimated costs for 2010-2011 varied by procedure type and patient status. These findings can be used to understand clinical management of DC and guide healthcare policy.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-12-73 contains supplementary material, which is available to authorized users.

Robert A Gerber, Richard Perry contributed equally to this work.

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Autor: Robert A Gerber - Richard Perry - Robin Thompson - Christopher Bainbridge

Fuente: https://link.springer.com/







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