Nationwide Medicare and Medicaid Trends in Management of Dupuytren’s Contracture

Background: In 2020, collagenase clostridium histolyticum (CCH) was withdrawn from markets in Europe, Asia, and Australia for Dupuytren’s contracture (DC). The impact of this withdrawal on US treatment patterns remains unclear. This study evaluates national trends in DC management across Medicare and Medicaid populations. Methods: Using data from the Centers for Medicare and Medicaid Services Physician/Supplier Procedure Summary, all DC-related procedure claims from 2012 to 2022 were identified using Current Procedural Terminology (CPT) codes for open partial palmar fasciotomy (26045), open fasciectomy (26121, 26123, 26125), percutaneous needle aponeurotomy (26040), and collagenase injection (20527). Claims were analyzed by year, provider type, and place of service, normalized per 100 000 total claims. Results: Between 2012 and 2022, 189 142 procedures were recorded. Overall intervention rates increased by 36%, from 35.87 to 49.10 per 100 000 claims. Collagenase injections rose 269%, while open fasciotomy declined 26%. Open fasciectomy remained the dominant treatment, accounting for over 60% of procedures. Notably, fasciectomy with digital release (26123, 26125) increased, while isolated palmar fasciectomy (26121) decreased. Office-based procedures rose from 14% to 21%, while ambulatory surgical centers remained most common (46% in 2022). Orthopedic surgeons were the leading providers, though hand specialists saw the largest proportional increase. Conclusion: Unlike international trends, US collagenase use continued to rise through 2022. Open fasciectomy remained primary, with a shift toward minimally invasive treatments and outpatient settings. Hand specialists are increasingly involved, though orthopedic surgeons lead in volume. These findings reflect evolving care models and highlight the need for continued monitoring of provider patterns and access to DC treatment.