Temporal Trends and Geographical Variation in Dupuytren Disease Surgery in England: A Population-Based Cohort Study

Background:
Dupuytren disease (DD) is a common fibroproliferative disease of the palmar fascia. The mainstay of DD treatment in England is surgery with either percutaneous needle fasciotomy, limited fasciectomy, or dermofasciectomy. This study aimed to investigate the temporal trends and geographical variation of primary DD surgery in England.

Methods:
A longitudinal population-based cohort study was perfomed using the Hospital Episode Statistics database from April 1, 2007, to March 31, 2017. Directly standarized rates were estimated over time (between financial years 2007–2008 and 2016–2017) and by geographic region (by clinical commissioning groups [CCGs]; financial years 2010–2011, 2013–2014, and 2016–2017). The Office for National Statistics midyear population estimates were used as the reference population.

Main Findings:
Primary DD surgery was undertaken at a steadily increasing rate from financial year 2007 to 2008, to 2016 to 2017 in England. There was a striking 3.6-fold variation in the rates of primary DD surgery among National Health Service CCGs in England place of residence.

Conclusions:
This significant variation in DD surgical treatment in England suggests a need for the development of standardized surgical practice across all CCGs and National Health Service hospitals, promoting equality of access to cost-effective health care.