char = A;code = 65
A decision analysis of amputation versus reconstruction for severe open tibial fracture from the physician and patient perspectives.char = A;code = 65
Publication: Ann Plast Surg 2011 Feb ;66(2)::185-91. :doi: 10.1097/SAP.0b013e3181cbfcce.
Publication Date: 2011 Feb
Study Author(s): Chung, Kevin C;Shauver, Melissa J;Saddawi-Konefka, Daniel;Haase, Steven C;
Institution: Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI, USA.
[email protected]
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Although reconstruction is often the primary choice of surgeons after an open tibial fracture, there is no evidence to support the long-term effectiveness of flap reconstruction over below-knee amputation. The aim of this study was to perform a decision analysis to evaluate treatment preferences for type IIIB and IIIC tibial fractures. Reconstructive microsurgeons, physical medicine physicians, and patients with lower extremity trauma completed a Web-based standard gamble utility survey to generate quality-adjusted life years (QALYs). Physicians assigned quite high utility values, and there was a slight preference for reconstruction over amputation, with a gain of only 0.55 QALY. Patients assigned significantly lower utility values and also favored reconstruction over amputation, but with a larger gain of 5.54 QALYs. The disparate utilities assigned by the physicians and the patients highlight the necessity of realistic discussion of outcomes, regardless of the management methods.
PMID: 20842003
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