Wide-Awake Partial Fasciectomy for Dupuytren Contracture: A Nationwide Analysis of Adverse Events and Reimbursement.

Background: Single-institution studies demonstrate reduced cost and similar outcomes for wide-awake fasciectomy compared with those with standard anesthesia. This retrospective cohort study examines these findings on a national level, comparing adverse events and cost for partial fasciectomies performed wide-awake and with standard anesthesia.

Methods: Partial fasciectomies were identified in the 2010-2022 PearlDiver database. Exclusion criteria were age younger than 18 years, <2 years of follow-up, inpatient surgery, and previous needle aponeurotomy or collagenase injection. Patients were stratified by anesthesia type and then matched by age, sex, Elixhauser Comorbidity Index score, geographic region, insurance, and number of fingers treated. The following postoperative events were identified: intraoperative digital nerve/vessel injury; 30-day wound complications; emergency department visits and returns for admission; and repeat fasciectomy, needle aponeurotomy, and collagenase injection within 2 years postoperatively. Total surgical reimbursement was determined by insurance type.

Results: Each matched cohort included 15,689 patients with no differences in age, sex, Elixhauser Comorbidity Index score, geographic region, insurance, or number of fingers treated. Patients with wide-awake surgery had fewer 30-day emergency department visits but no differences in intraoperative nerve/vessel injury, wound complications, or returns for admission. Wide-awake patients had slightly greater rate of subsequent interventions for Dupuytren contracture within 2 years of index surgery. Wide-awake surgery was associated with markedly reduced total reimbursement.

Conclusion: There is much debate about and investigation of the costs and benefits of the different treatment modalities for Dupuytren contracture. The ability to perform fasciectomies wide-awake can reduce the cost of fasciectomy without sacrificing safety. This may play an important role in treatment decisions because fasciectomy is generally considered the benchmark, yet most expensive, treatment option.