Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the University of Michigan Medical School; and the University of Michigan's Stephen M. Ross School of Business.
Plast Reconstr Surg. 2009 Dec;124(6):1965-1973. doi: 10.1097/PRS.0b013e3181bcf156.
Lower extremity trauma is common. Despite an abundance of literature on severe injuries that can be treated with salvage or amputation, the appropriate management of these injuries remains uncertain. In this situation, a cost-utility analysis is an important tool in providing an evidence-based practice approach to guide treatment decisions.
Costs following amputation and salvage were derived from data presented in a study that emerged from the Lower Extremity Assessment Project. The authors extracted relevant data on projected lifetime costs and analyzed them to include discounting and sensitivity analysis by considering patient age. The utilities for the various health states (amputation or salvage, including possible complications) were measured previously using the standard gamble method and a decision tree simulation to determine quality-adjusted life-years.
Amputation is more expensive than salvage, independently of varied ongoing prosthesis needs, discount rate, and patient age at presentation. Moreover, amputation yields fewer quality-adjusted life-years than salvage. Salvage is deemed the dominant, cost-saving strategy.
Unless the injury is so severe that salvage is not a possibility, based on this economic model, surgeons should consider limb salvage, which will yield lower costs and higher utility when compared with amputation.
下肢创伤很常见。尽管有大量关于可通过挽救或截肢治疗的严重损伤的文献，但这些损伤的适当处理仍然不确定。在这种情况下，成本效益分析是提供循证实践方法的重要工具，可指导治疗决策。
截肢和挽救后的成本来自于下肢评估项目研究中提出的数据。作者提取了关于预期终身成本的相关数据，并通过考虑患者年龄进行贴现和敏感性分析进行了分析。使用标准赌博法和决策树模拟测量了各种健康状态（截肢或挽救，包括可能的并发症）的效用，以确定质量调整生命年。
截肢比挽救更昂贵，而与不断变化的假体需求、贴现率以及患者就诊时的年龄无关。此外，截肢比挽救产生的质量调整生命年更少。挽救被认为是节省成本的主导策略。
除非根据该经济模型，损伤非常严重以至于无法进行挽救，否则外科医生应考虑保肢，与截肢相比，保肢可降低成本并提高效用。
