修复还是置换？老年下肢骨折治疗的患者偏好：一项离散选择实验。
Fix or Replace? Patient Preferences for the Treatment of Geriatric Lower Extremity Fractures: A Discrete Choice Experiment.
作者信息
Richards John T, O'Hara Nathan N, Healy Kathleen, Zingas Nicolas, McKibben Natasha, Benzel Caroline, Slobogean Gerard P, O'Toole Robert V, Sciadini Marcus F
机构信息
Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Author's name insert query plzJ. T. Richards is an employee of the US Government. This work was prepared as part of their official duties. Title 17 U.S.C.§105 provides that "Copyright protection under this title is not available for any work of the United States Government." Title 17 U.S.C. §101 defined a US Government work as a work prepared by a military service member or employees of the US Government as part of that person's official duties. The opinions or assertions contained in this paper are the private views of the authors and are not to be construed as reflecting the views, policy or positions of the Department of the Navy, Department of Defense nor the US Government.
出版信息
Geriatr Orthop Surg Rehabil. 2024 Feb 28;15:21514593241236647. doi: 10.1177/21514593241236647. eCollection 2024.
INTRODUCTION
When considering treatment options for geriatric patients with lower extremity fractures, little is known about which outcomes are prioritized by patients. This study aimed to determine the patient preferences for outcomes after a geriatric lower extremity fracture.
MATERIALS AND METHODS
We administered a discrete choice experiment survey to 150 patients who were at least 60 years of age and treated for a lower extremity fracture at a Level I trauma center. The discrete choice experiment presented study participants with 8 sets of hypothetical outcome comparisons, including joint preservation (yes or no), risk of reoperation at 6 months and 24 months, postoperative weightbearing status, disposition, and function as measured by return to baseline walking distance. We estimated the relative importance of these potential outcomes using multinomial logit modeling.
RESULTS
The strongest patient preference was for maintained function after treatment (59%, < .001), followed by reoperation within 6 months (12%, < .001). Although patients generally favored joint preservation, patients were willing to change their preference in favor of joint replacement if it increased function (walking distance) by 13% (SE, 66%). Reducing the short-term reoperation risk (12%, < .001) was more important to patients than reducing long-term reoperation risk (4%, = .33). Disposition and weightbearing status were lesser priorities to patients (9%, < .001 and 7%, < .001, respectively).
DISCUSSION
After a lower extremity fracture, geriatric patients prioritized maintained walking function. Avoiding short-term reoperation was more important than avoiding long-term reoperation. Joint preservation through fracture fixation was the preferred treatment of geriatric patients unless arthroplasty or arthrodesis provides a meaningful functional benefit. Hospital disposition and postoperative weightbearing status were less important to patients than the other included outcomes.
CONCLUSIONS
Geriatric patients strongly prioritize function over other outcomes after a lower extremity fracture.
引言
在考虑老年下肢骨折患者的治疗方案时，对于患者优先考虑哪些治疗结果知之甚少。本研究旨在确定老年下肢骨折患者对治疗结果的偏好。
材料与方法
我们对150名年龄至少60岁且在一级创伤中心接受下肢骨折治疗的患者进行了离散选择实验调查。离散选择实验向研究参与者展示了8组假设的治疗结果比较，包括关节保留（是或否）、6个月和24个月时再次手术的风险、术后负重状态、出院安排以及通过恢复到基线步行距离来衡量的功能。我们使用多项logit模型估计这些潜在治疗结果的相对重要性。
结果
患者最强烈的偏好是治疗后保持功能（59%，P <.001），其次是6个月内再次手术（12%，P <.001）。尽管患者总体上倾向于保留关节，但如果关节置换能使功能（步行距离）提高13%（标准误，66%），患者愿意改变偏好选择关节置换。降低短期再次手术风险（12%，P <.001）对患者来说比降低长期再次手术风险（4%，P =.33）更重要。出院安排和负重状态对患者来说优先级较低（分别为9%，P <.001和7%，P <.001）。
讨论
下肢骨折后，老年患者将保持步行功能列为首要考虑因素。避免短期再次手术比避免长期再次手术更重要。除非关节成形术或关节融合术能提供显著的功能益处，通过骨折固定保留关节是老年患者的首选治疗方法。医院出院安排和术后负重状态对患者来说不如其他纳入的治疗结果重要。
结论
老年下肢骨折患者在功能方面的优先级明显高于其他治疗结果。
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