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

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.