Wong Alison, Burke Cynthia E, Bangura Abdulai, O'Hara Nathan N, Mundy Lily, O'Toole Robert V, Pensy Raymond A
Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
Ann Surg. 2023 Jan 1;277(1):21-27. doi: 10.1097/SLA.0000000000005470. Epub 2022 Jul 7.
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.
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.
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.
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.
Patients with limb-threatening injuries most valued gains in function and reduced out-of-pocket costs.
确定对于肢体严重损伤患者而言，哪些结果最为重要，以及这些偏好是否会因患者的治疗方式（保肢与截肢）、健康状况、人口统计学特征或受伤后的时间而有所不同。
对于肢体严重损伤后促使患者选择治疗方式的偏好，我们了解得并不充分。离散选择实验（DCE）是一种用于量化偏好的可靠调查方法。
选取2010年1月至2020年12月有创伤性肢体严重损伤病史的患者，让他们完成一份包含我们的DCE以及患者报告结局测量信息系统（PROMIS）问卷的调查。DCE的属性包括恢复时间、功能、外观、费用和住院时间。我们使用条件logit模型在0%至100%的范围内估计每个属性的相对重要性，确定为改善所包含属性愿意支付的费用，并根据患者特征（包括PROMIS评分）评估偏好的差异。
共有150名患者完成了调查（104例行保肢治疗，46例行截肢手术；平均年龄48±16岁；79%为男性）。恢复伤前功能[相对重要性=41%；95%置信区间（CI），37%-45%]和将费用降至最低（24%；95%CI，21%-28%）最为重要。外观变化最不重要（7%；95%CI，5%-9%）。保肢或截肢患者的偏好层次没有差异，但患者年龄、身心健康状况和收入与偏好差异有关。
肢体严重损伤患者最看重功能的改善和自付费用的降低。
