Frequency and Reporting of Complications after Dupuytren Contracture Interventions: A Systematic Review and Meta-Analysis.

Abstract

BACKGROUND: Numerous complications are reported following interventions for Dupuytren 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. METHODS: Patient demographics, interventions, complications, their management, and outcomes were extracted. Analysis of descriptive data enabled review of reporting. Meta-analysis (MA) of noncomparative data sets enabled estimation of proportions of patients experiencing complications. Network meta-analysis (NMA) of comparative studies estimated the relative occurrence of complications between interventions. RESULTS: Twenty-six 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 3 common complications across all interventions; the reported rates for LF were 4.5% for infection, 3% for nerve injury, and 3.3% for CRPS. LF, the most common intervention, was used as the reference intervention for comparison of the most common complications via NMA, including hematoma (OF odds ratio, 0.450 [95% CI, 0.277 to 0.695]; PNF odds ratio, 0.245 [95% CI, 0.114 to 0.457]), infection (PNF odds ratio, 0.2 [95% CI, 0.0287 to 0.690]; DF odds ratio, 2.02 [95% CI, 1.02 to 3.74]), and neurapraxia [PNF odds ratio, 0.0926 [95% CI, 0.00553 to 0.737]). CONCLUSIONS: There was limited reporting of complication occurrence, management, and outcomes, contributing to a gap in information for informed patient consent. MA was possible for reporting of proportions for infection, nerve injury, and CRPS. NMA enabled direct comparison of the 6 most common complications between interventions. Improving consistency and quality in complications reporting aids counseling of patients regarding the true rates and consequences of the risks of interventions, which can guide selection.