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Comparative Study
. 2011 Feb;66(2):185-91.
doi: 10.1097/SAP.0b013e3181cbfcce.

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

Kevin C Chung  1 , Melissa J Shauver, Daniel Saddawi-Konefka, Steven C Haase
Affiliations
Comparative Study

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

Kevin C Chung et al. Ann Plast Surg. 2011 Feb.

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.

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Figures

Figure 1
Figure 1
Equation for utility
Figure 2
Figure 2
Type IIIB and IIIC tibial fracture decision tree structure
Figure 3
Figure 3
Equation for QALYs
Figure 4
Figure 4
Type IIIB and IIIC tibial fracture decision tree
Figure 5
Figure 5
Sensitivity analysis on healthy remaining years of life using physician-rated utilities
Figure 6
Figure 6
Sensitivity analysis on healthy remaining years of life using patient-rated utilities
See this image and copyright information in PMC

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