Frequency and reporting of complications after Dupuytren's contracture interventions: A systematic review and meta-analysis

P Raval; K Kulkarni; N Johnson; P Divall; C Nevill; A Sutton; J Dias

doi:10.1097/PRS.0000000000011440

Frequency and reporting of complications after Dupuytren's contracture interventions: A systematic review and meta-analysis

Plast Reconstr Surg. 2024 Mar 29. doi: 10.1097/PRS.0000000000011440. Online ahead of print.

Authors

P Raval¹, K Kulkarni², N Johnson³, P Divall⁴, C Nevill⁵, A Sutton⁶, J Dias⁷

Affiliations

¹ Post- CCT Upper Limb Fellow, University Hospitals of Leicester, Leicester, UK.
² Consultant Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK.
³ Consultant Trauma and Orthopaedic Surgeon, Trauma and Orthopaedics, Derby Hospital, University of Leicester, Leicester, UK.
⁴ Ms Pip Divall Information specialist, Clinical librarian, University Hospitals of Leicester, Leicester, UK.
⁵ Department of Population Health Sciences, University of Leicester, Leicester, UK.
⁶ Professor of Medical Statistics, Department of Population Health Sciences, University of Leicester, Leicester, UK.
⁷ Professor of Hand and Orthopaedic Surgery, Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK.

PMID: 38548710
DOI: 10.1097/PRS.0000000000011440

Abstract

Introduction: Numerous complications are reported following interventions for Dupuytren's contracture; however, their incidence, management, and outcomes remain poorly reported. The aims of this review were to report the proportions of complications, compare likelihood of complications between interventions, and evaluate reporting of complications, including assessment, grading, management, and subsequent reporting of their impact on patient outcomes.

Methods: Extracted data included patient demographics, intervention details, complications, their management, and final outcomes. Analysis of descriptive data enabled review of complications reporting. Meta-analysis(MA) of non-comparative datasets enabled estimation of proportions of patients experiencing complications. Network meta-analysis(NMA) of comparative studies estimated the relative occurrence of complications between interventions. Risk of bias analysis was performed.

Results: 26 studies, comprising 10,831 patients, were included. Interventions included collagenase injection, percutaneous needle fasciotomy(PNF), limited fasciectomy(LF), open fasciotomy(OF), and dermofasciectomy(DF). Overall quality and consistency of outcomes reporting was poor. MA enabled estimates of probabilities for three common complications(infection, nerve injury, complex regional pain syndrome(CRPS)) across all interventions; the reported rates for LF were 4.5% for infection, 3% for nerve injury, and 3.3% for CRPS. As the commonest intervention, LF was used as the reference intervention for comparison of the commonest complications via NMA, including haematoma [OF OR 0.450(0.277, 0.695); PNF OR 0.245(0.114, 0.457)], infection [PNF OR 0.2(0.0287, 0.690); DF OR 2.02(1.02, 3.74)], and neuropraxia [PNF OR 0.0926(0.00553, 0.737)]. We noted that the complication incidence was higher the more invasive the intervention.

Conclusions: There was limited reporting of complication occurrence, management, and outcomes following interventions, contributing to a gap in information for informed patient consent. MA was possible for reporting of proportions for infection, nerve injury, and CRPS across interventions. NMA enabled direct comparison of the six commonest complications between interventions. These findings can guide intervention selection. Improving consistency and quality in complications reporting is essential to aid counselling of patients regarding the true rates and consequences of the risks of interventions.

Type of study/level of evidence: 2.