Nishizuka Takanobu, Shauver Melissa J, Zhong Lin, Chung Kevin C, Hirata Hitoshi
Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, University of Michigan, Ann Arbor, MI.
J Hand Surg Am. 2015 Aug;40(8):1646-56, 1656.e1-3. doi: 10.1016/j.jhsa.2015.05.026.
To compare the societal preferences for finger replantation between the United States (US) and Japan and to investigate factors influencing the preferences.
A sample of the general population without current hand disease or condition was recruited via flyers posted in public areas of 2 major academic centers in the US and Japan. The recruited subjects completed a survey presenting finger amputation scenarios and various factors that may affect treatment decisions. We performed univariate analysis using treatment preference as the outcome and all other factors as possible predictors using the chi-square test.
Most respondents in both countries preferred replantation and there was no significant difference between the US and Japan. Treatment preference was significantly associated with the importance of appearance, recovery time, and the chance of survival of the replanted digit. There was no association between treatment preference and attitudes regarding body integrity or estimate of stigma toward finger amputees. Japanese participants agreed more with statements of body integrity, and Japanese respondents rated appearance, sensation, and chance of survival of the replant as more important than did American participants.
Patient preference is not driving the decrease in finger replantations in the US. The general public in both countries prefer replantation over wound closure for digit amputations.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and decision analysis III.
比较美国和日本社会对断指再植的偏好,并调查影响这些偏好的因素。
通过在美国和日本两个主要学术中心的公共区域张贴传单,招募没有手部疾病或病症的普通人群样本。招募的受试者完成了一项调查,该调查呈现了手指截肢的情景以及可能影响治疗决策的各种因素。我们以治疗偏好为结果,以所有其他因素为可能的预测因素,使用卡方检验进行单变量分析。
两国的大多数受访者都倾向于再植,美国和日本之间没有显著差异。治疗偏好与外观的重要性、恢复时间以及再植手指的存活几率显著相关。治疗偏好与对身体完整性的态度或对手指截肢者耻辱感的估计之间没有关联。日本参与者更认同身体完整性的陈述,并且日本受访者认为再植的外观、感觉和存活几率比美国参与者认为的更重要。
患者的偏好并非导致美国断指再植数量减少的原因。两国的普通公众在手指截肢时都更倾向于再植而非伤口闭合。
研究类型/证据水平:经济与决策分析III。