gms | German Medical Science

Background: Collagenase of clostridium histolyticum (CCH) is a therapeutic alternative for Dupuytren disease. Although his efficacy and safety are well stablish few data exist about patient satisfaction.

Objectives:

• Stablish patient satisfaction with CCH treatment.
• Compare patient satisfaction with efficacy and complications appeared.

Methods:

• Prospective nonrandomized single center cohort study.
• Inclusion criteria: passive extension deficit at metacarpophalangeal (MCP) joint > 20º or proximal interphalangeal (PIP) joint > 15º treated with CCH between 2012 and 2017.
• Extension deficit and complications were registered at manipulation day, 1st month, 3-6 months, 12 months and discharge.
• Satisfaction was evaluated using the Southampton Dupuytren scoring scheme at the end of follow up.
• Clinical success when flexion contracture was < 5º in day 30 post injection.
• Clinically acceptable when passive extension was less than 20º in MCP joint or 10º of the PIP joint in day 30 post injection.
• Recurrence when global contracture was > 20º after clinical success.
• P values below 0.05 were considered significant.

Results and Conclusions:

• 159 collagenase injections performed in 137 patients.
• For joints, baseline extension deficit at MCP affected joints (40,9%) was 37,6º(SD±17,7), at PIP joints (17%) was 56,9º(SD±25,5) and at MCP+PIP joints (42.1%) was 75,3º(DS±36,1).
• 5th finger was the most common affected in 48,4% cases.
• Globally mean total extension deficit decreased 90% after manipulation
• Global Clinical success was achieved at 68.02 % of cases
• Global Clinically acceptable results were achieved at 7.54 % of cases,
• Global Recurrence at 12 months appeared in 9.4% of cases.
• After asking the patients about CCH treatment, 69.6% declared to be satisfied.
• 76.1% of patients reported to have had problems with the treatment, but 72.4% of them, referred none or minor concerns when complications appeared.
• The satisfaction analysis revealed that when success was achieved, satisfaction was higher (74% vs 40% satisfied) p=0.02 and patients would repeat treatment (70.7% vs 16.2%) p=0.04.
• There were no significant differences in global satisfaction related to occurrence of complications (73.9% vs 68.5% satisfied) p=0.695.
• When recurrence appeared 57.1% vs 78.5% of patients declared to be satisfied/very satisfied. P=0.1 but only 52.4 vs 75.6 % would repeat treatment with CCH. p= 0.007.

Conclusion:

• Patient satisfaction with Collagenase injection procedure is high.
• Complications appeared with the treatment does not change patient satisfaction.