Determining Risk Factors and Rate of Surgery After Collagenase Injections for Dupuytren Contracture

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-06-30 DOI:10.1016/j.jhsg.2025.100768

Ryan C. Cha BA , Juliet S. Chung MD , Sina Ramtin MD , Asif M. Ilyas MD, MBA

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Abstract

Purpose

Collagenase injections are a nonsurgical treatment for Dupuytren contracture, but their long-term effectiveness in preventing surgery remains unclear. This study aimed to evaluate the rate of surgical intervention following collagenase treatment and identify whether specific risk factors increase the likelihood of future surgical correction.

Methods

This retrospective cohort study utilized the TriNetX US Collaborative network to identify patients diagnosed with Dupuytren contracture between January 2007 and September 2024. Patients initially treated with collagenase injections were identified using relevant current procedural terminology codes. Procedure-specific current procedural terminology codes were then used to determine which patients underwent a subsequent fasciectomy or fasciotomy within 5 years of their initial injection. Risk factors, including smoking, diabetes, alcohol abuse, epilepsy, and vascular disease, were identified by International Classification of Diseases, 10th Edition codes. Statistical analysis was performed to evaluate the association between these risk factors and the likelihood of undergoing surgery.

Results

Among 6,917 patients identified to have been treated with collagenase, 715 (10.2%) underwent surgery within 5 years of the injection. Tobacco use was associated with a significantly higher rate of surgery (12.98%, P = .03) compared with nonsmokers (10.1%). Similarly, patients with alcohol use disorder had a higher surgical correction rate (16.3%, P < .001) compared with those without (9.8%).

Conclusions

Approximately 10% of patients treated with collagenase injections for Dupuytren contracture underwent surgery within 5 years. Smoking and alcohol use significantly increased the likelihood of surgery, representing a potential correlation. Further research is warranted to explore mechanisms underlying progression to surgery and prevention strategies.

Type of study/level of evidence

Prognostic/III.

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确定胶原酶注射治疗双膝挛缩的危险因素和手术率

目的胶原酶注射是一种非手术治疗双膝挛缩的方法，但其预防手术的长期有效性尚不清楚。本研究旨在评估胶原酶治疗后的手术干预率，并确定特定的危险因素是否会增加未来手术矫正的可能性。方法本回顾性队列研究利用TriNetX美国协作网络识别2007年1月至2024年9月诊断为Dupuytren挛缩的患者。最初接受胶原酶注射治疗的患者使用相关的现行程序术语代码进行识别。然后使用特定程序的现行程序术语代码来确定哪些患者在首次注射后的5年内接受了后续筋膜切除术或筋膜切开术。危险因素，包括吸烟、糖尿病、酗酒、癫痫和血管疾病，由《国际疾病分类》第10版代码确定。对这些危险因素与手术可能性之间的关系进行统计分析。结果6917例接受胶原酶治疗的患者中，715例（10.2%）在注射后5年内接受了手术。吸烟与手术率（12.98%,P = 0.03）显著高于不吸烟者（10.1%）。同样，酒精使用障碍患者的手术矫正率更高(16.3%,P <；.001)，而无此症状者（9.8%）。结论在接受胶原酶注射治疗的患者中，约有10%的患者在5年内接受了手术治疗。吸烟和饮酒显著增加了手术的可能性，代表了一种潜在的相关性。需要进一步的研究来探索手术进展的机制和预防策略。研究类型/证据水平预后性/

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