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A decision analysis of amputation versus reconstruction for severe open tibial fracture from the physician and patient perspectives.


ABSTRACT: 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.

SUBMITTER: Chung KC 

PROVIDER: S-EPMC4382673 | biostudies-literature | 2011 Feb

REPOSITORIES: biostudies-literature

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A decision analysis of amputation versus reconstruction for severe open tibial fracture from the physician and patient perspectives.

Chung Kevin C KC   Shauver Melissa J MJ   Saddawi-Konefka Daniel D   Haase Steven C SC  

Annals of plastic surgery 20110201 2


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 gener  ...[more]

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