Percutaneous needle fasciotomy for Dupuytren's disease: A one-stop approach incidentally suited to the era of COVID-19

[Medium-term Results after percutaneous Needle Fasciotomy in Dupuytren's Disease]

BACKGROUND

Dupuytren's disease often leads to an increasing limitation in finger extension in affected patients. As the incidence rises with age, the number of cases is expected to rise in the future due to the demographic change. Therefore, an easy and patient-oriented treatment is required. In the following study, we investigated the short and medium-term results after percutaneous needle fasciotomy (PNF).

PATIENTS AND METHODS

Overall, 65 fingers of 40 patients were treated with PNF. We evaluated the total passive deficit of extension (TPED), the passive deficit of extension of the joints (PED), the Buck-Gramcko score, rate of recurrence, DASH score and patient satisfaction. The average age of the patients was 65,9 years. Most of the patients (82%) were male.

RESULTS

Directly after the PNF, extension in the treated fingers improved significantly (TPED before PNF 74,6°±41,1 SD to 32,8°±29,0 SD after the procedure). By the time of the follow-up examination (30,2±13,9 SD months), TPED had increased again (52,7°±40,2 SD). The rate of recurrence was 29,7%, and a higher Tubiana stage before the procedure correlated significantly with a higher recurrence rate. Nevertheless, patients demonstrated a very high level of satisfaction with the procedure and almost all patients would choose to undergo PNF again.

CONCLUSION

Although it is associated with a relatively high recurrence rate, PNF represents an effective and patient-oriented treatment of Dupuytren's contracture.

Impact of one-stop clinic on the clearance of COVID-19 surgical backlog

Objective

During the COVID-19 pandemic, there was a significant decrease in the number of operated elective cases due to the shutdown procedures. This situation created a substantial surgical backlog. Several visits are generally necessary before a surgical decision making and booking the surgery time. Improving patient access by creating "one-stop" clinics might help decrease the number of visits before the surgery. This study investigated the effect of one-stop clinic application as a new care model on COVID-19 surgical backlog clearance.

Methods

We conducted a quasi-experimental, interrupted time-series, pretest-posttest study design in the northern areas of Saudi Arabia. The study outcomes were the number of surgeries and the time elapsed from the first seen day to the booked room day.

Results

A total of 358 surgeries were included. Of them, 107 (29.9%) surgeries were performed before initiation of the one-stop clinic and 251 (70.1%) after initiation. The median (quartile Q1, Q3) time elapsed from the first seen day until the booked OR day post-one-stop clinic was 10 (6-17), which was significantly lower than pre-one-stop clinic 20 (11-33), P < 0.0001.

Conclusion

One-stop clinics shortened the period between first visit and booking in the operating room. One-stop clinics may alleviate the surgical backlog resulting from the COVID-19 crisis.