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What Outcomes Are Most Important to Patients Following a Lower Extremity Limb-threatening Injury?

Publication ,  Journal Article
Wong, A; Burke, CE; Bangura, A; O'Hara, NN; Mundy, L; O'Toole, RV; Pensy, RA
Published in: Ann Surg
January 1, 2023

OBJECTIVE: To determine what outcomes are most important to patients after a limb-threatening injury, and if those preferences vary based on the patients' treatment (salvage vs amputation), health, demographics, or time since injury. BACKGROUND: The preferences that motivate the patients' choice of treatment following a limb-threatening injury are poorly understood. Discrete choice experiments (DCEs) are a robust survey methodology to quantify preferences. METHODS: Patients with a history of traumatic limb-threatening injury, January 2010 to December 2020, completed a survey with our DCE and the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. The DCE attributes included recovery time, function, appearance, cost, and time in hospital. We used conditional logit modeling to estimate the relative importance of each attribute on a scale of 0% to 100%, determine willingness to pay for improvements in the included attributes, and assess variation in preferences based on patient characteristics, including PROMIS score. RESULTS: A total of 150 patients completed the survey (104 limb salvage, 46 amputation; mean age, 48±16 years; 79% male). Regaining preinjury function [relative importance=41%; 95% confidence interval (CI), 37%-45%] and minimizing costs (24%; 95% CI, 21%-28%) were of greatest importance. Changes in appearance were least important (7%; 95% CI, 5%-9%). The hierarchy of preferences did not vary between those who had limb salvage or amputation, but patient age, physical and mental health, and income were associated with preference variation. CONCLUSIONS: Patients with limb-threatening injuries most valued gains in function and reduced out-of-pocket costs.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

January 1, 2023

Volume

277

Issue

1

Start / End Page

21 / 27

Location

United States

Related Subject Headings

  • Surgery
  • Middle Aged
  • Male
  • Lower Extremity
  • Leg Injuries
  • Humans
  • Health Expenditures
  • Female
  • Amputation, Surgical
  • Adult
 

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Wong, A., Burke, C. E., Bangura, A., O’Hara, N. N., Mundy, L., O’Toole, R. V., & Pensy, R. A. (2023). What Outcomes Are Most Important to Patients Following a Lower Extremity Limb-threatening Injury? Ann Surg, 277(1), 21–27. https://doi.org/10.1097/SLA.0000000000005470
Wong, Alison, Cynthia E. Burke, Abdulai Bangura, Nathan N. O’Hara, Lily Mundy, Robert V. O’Toole, and Raymond A. Pensy. “What Outcomes Are Most Important to Patients Following a Lower Extremity Limb-threatening Injury?Ann Surg 277, no. 1 (January 1, 2023): 21–27. https://doi.org/10.1097/SLA.0000000000005470.
Wong A, Burke CE, Bangura A, O’Hara NN, Mundy L, O’Toole RV, et al. What Outcomes Are Most Important to Patients Following a Lower Extremity Limb-threatening Injury? Ann Surg. 2023 Jan 1;277(1):21–7.
Wong, Alison, et al. “What Outcomes Are Most Important to Patients Following a Lower Extremity Limb-threatening Injury?Ann Surg, vol. 277, no. 1, Jan. 2023, pp. 21–27. Pubmed, doi:10.1097/SLA.0000000000005470.
Wong A, Burke CE, Bangura A, O’Hara NN, Mundy L, O’Toole RV, Pensy RA. What Outcomes Are Most Important to Patients Following a Lower Extremity Limb-threatening Injury? Ann Surg. 2023 Jan 1;277(1):21–27.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

January 1, 2023

Volume

277

Issue

1

Start / End Page

21 / 27

Location

United States

Related Subject Headings

  • Surgery
  • Middle Aged
  • Male
  • Lower Extremity
  • Leg Injuries
  • Humans
  • Health Expenditures
  • Female
  • Amputation, Surgical
  • Adult