Dupuytren Disease

POS1383 THE ASSOCIATION BETWEEN BARIATRIC SURGERY AND DUPUYTREN DISEASE: A COHORT STUDY FROM SWEDISH NATIONWIDE HEALTHCARE REGISTRIES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4067 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 974.3-975

Author(s):

T. Burkard ◽

J. Lane ◽

D. Holmberg ◽

A. M. Burden ◽

D. Furniss

Keyword(s):

Bariatric Surgery ◽

Body Mass Index ◽

Weight Loss ◽

Cohort Study ◽

Secondary Care ◽

High Body Mass Index ◽

Null Result ◽

Increased Risk ◽

Dupuytren Disease

Background:Dupuytren disease (DD) is multifactorial, with several genetic and environmental risk factors contributing to disease susceptibility. High body mass index, however, was suggested to be protective of DD.1 The impact of weight loss among obese patients on DD has not been assessed to date.Objectives:To assess the association between bariatric surgery and DD in a secondary care setting.Methods:We performed a propensity score (PS)-matched cohort study using data from Swedish nationwide healthcare registries (patient registry [secondary care], causes of death registry, prescribed drug registry). Patients aged 30-79 years who underwent bariatric surgery between 2006 and 2019 were matched to up to 2 obese bariatric surgery-free patients (called unexposed patients) based on their PS. PS-matching was carried out in risk set sampling to reduce selection bias, within 4 sequential cohort entry blocks to account for time trend biases. The outcome DD was defined as a diagnosis of DD in secondary care or partial or total fasciotomy of wrist or hand. After a 1-year run-in period, patients were followed in an “as-treated” approach. We applied Cox proportional hazard regression to calculate hazard ratios (HR) with 95% confidence intervals (CIs) of incident DD among bariatric surgery patients when compared to obese unexposed patients overall, and in subgroups of age, sex, bariatric surgery type, and by duration of follow-up.Results:A total of 34 959 bariatric surgery patients were PS-matched to 54 769 obese unexposed patients. A total of 71.6% of bariatric surgery patients were women. Bariatric surgery patients had a mean age of 45.5 years and a mean follow-up of 6.9 years. All patient characteristics in obese unexposed patients were highly similar. We observed 126 and 136 severe DD cases among bariatric surgery and obese unexposed patients, respectively. The risk of DD was significantly increased in bariatric surgery patients compared to obese unexposed patients (HR = 1.30, 95% CI 1.02-1.65). The risk of DD was higher in women (HR = 1.36, 95% CI 1.00-1.84) than in men (HR = 1.05, 95% CI 0.70-1.58). Age did not modify the risk of DD among bariatric surgery patients compared to obese unexposed patients. Malabsorptive bariatric surgery yielded an increased risk of DD when compared to obese unexposed patients (HR = 1.33, 95% CI 1.04-1.71), while restrictive bariatric surgery yielded a null result. The risk of DD increased with duration of follow-up (>5 years of follow-up: HR = 1.63, 95% CI 1.14-2.34, null result in earlier follow-up).Conclusion:Our results suggest that substantial weight loss is associated with a latent increased risk of severe DD in an obese population. This observation further strengthens current evidence that high body mass index is protective against DD. The latency of risk increase of DD after bariatric surgery may suggest that slowly adapting metabolic changes may be part of the mechanism of DD emergence.References:[1]Hacquebord JH, Chiu VY, Harness NG. The Risk of Dupuytren Surgery in Obese Individuals. J Hand Surg Am. 2017, 42: 149–55.Acknowledgements:We thank Prof. Dr. Jesper Lagergren (Karolinksa Institutet, Stockholm, Sweden) for hosting Dr. Theresa Burkard for a research stay at the Upper Gastrointestinal Surgery Group and making the data available for use. Furthermore, we thank Dr. Giola Santoni (Karolinksa Institutet, Stockholm, Sweden) for her technical support.Disclosure of Interests:None declared

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A nonsurgical therapy for Dupuytren disease

Nature Reviews Rheumatology ◽

10.1038/nrrheum.2009.255 ◽

2010 ◽

Vol 6 (1) ◽

pp. 7-8 ◽

Cited By ~ 7

Author(s):

Ardeshir Bayat

Keyword(s):

Nonsurgical Therapy ◽

Dupuytren Disease

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Collagenase Treatment for Dupuytren Disease of the Thumb and First Web

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2015.12.003 ◽

2016 ◽

Vol 41 (3) ◽

pp. 348-353.e1 ◽

Cited By ~ 4

Author(s):

Marieke M. Dreise ◽

Martin W. Stenekes ◽

Paul M.N. Werker

Keyword(s):

Collagenase Treatment ◽

Dupuytren Disease

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Hand Clinics ◽

10.1016/j.hcl.2018.04.004 ◽

2018 ◽

Vol 34 (3) ◽

pp. xi

Author(s):

Steven C. Haase ◽

Kevin C. Chung

Keyword(s):

Dupuytren Disease

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The “Y” Double Spiral Cord: An Anatomic Variant of Dupuytren Disease

JBJS Case Connector ◽

10.2106/jbjs.cc.20.00793 ◽

2021 ◽

Vol 11 (2) ◽

Author(s):

James Hubbard ◽

Sean S. Li ◽

Aakash Chauhan ◽

Reid Abrams

Keyword(s):

Anatomic Variant ◽

Double Spiral ◽

Dupuytren Disease

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Surgical Treatment for Recurrent Dupuytren Disease

Hand ◽

10.1177/15589447211060447 ◽

2021 ◽

pp. 155894472110604

Author(s):

Bryan A. Hozack ◽

Ghazi M. Rayan

Keyword(s):

Skin Grafting ◽

Full Thickness ◽

Surgical Strategies ◽

Full Thickness Skin ◽

Thickness Skin ◽

Collagenase Injection ◽

Pip Joint ◽

Partial Fasciectomy ◽

Ray Amputation ◽

Dupuytren Disease

Background: Revision procedures for recurrent Dupuytren disease (DD) can be difficult and carry a high risk of complications. Our goal was to describe surgical strategies used for cases of recurrence and report on their outcomes. Methods: We reviewed 1 surgeon’s operative cases for recurrent DD performed at 1 institution. Prior procedures included collagenase injection, percutaneous needle fasciotomy, or open surgical fasciectomy in the same digit or area of the hand. Results: From January 1981 to December 2020, 54 procedures were performed on 33 patients for recurrent DD. Most patients were men (82%), had bilateral involvement (64%) and family history (52%), and some had ectopic disease in their feet (24%). The small finger was involved in 76% of the cases, and the proximal interphalangeal (PIP) joint was involved in 83% of these digits. The procedures included 38 partial fasciectomies (72%), 12 dermofasciectomies (23%), 3 radical fasciectomies (6%), 1 of each needle fasciotomy, ray amputation, and PIP joint arthrodesis (2%). Twenty-three patients (43%) required full thickness skin grafts with an average area of 7.1 cm2 (range: 1-20 cm2). Conclusions: This study highlights the complexity of recurrent DD case management and found the treatment required for 95% of patients in this series was open partial fasciectomy with or without demofasciectomy. Full thickness skin grafting was necessary in nearly half of the cases.

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