title: 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.
authors.affiliation: Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI, USA. kecchung@umich.edu
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Shauver
authors.forename: Daniel
authors.initials: D
authors.lastname: Saddawi-Konefka
authors.forename: Steven C
authors.initials: SC
authors.lastname: Haase
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D003661:Decision Support Techniques; D005260:Female; D005597:Fractures, Open / Q000145:classification / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D057240:Patient Preference; D010818:Practice Patterns, Physicians'; D019651:Plastic Surgery Procedures / Q000379:methods*; D013978:Tibial Fractures / Q000145:classification / Q000601:surgery*; D055815:Young Adult