The following is the summary of “What Outcomes Are Most Important to Patients Following a Lower Extremity Limb-threatening Injury?” published in the January 2023 issue of Surgery by Wong, et al.
The purpose of this study is to learn which outcomes patients value most after sustaining a limb-threatening injury, and whether these values alter according to treatment (salvage vs. amputation), health, demographics, and length of time after injury. Despite the seriousness of limb-threatening injuries, little is known about the preferences that drive patients’ choice of therapy. Discrete choice experiments (DCEs) are a reliable means of surveying preferences quantitatively.
Researchers used the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire and surveyed patients who had had a catastrophic limb-threatening injury between January 2010 and December 2020 using our DCE. Factors such as hospital stay, cost, and how quickly patients recovered functioned as part of the DCE. We utilized conditional logit modeling to estimate, on a scale from 0% to 100%, the relative importance of each trait, the willingness to pay for improvements in the included qualities, and the variance in preferences based on patient factors, such as the PROMIS score.
The data shows that 150 patients participated in the survey (104 underwent limb salvage, and 46 underwent amputation; mean age, 4,816 years; 79% were male). Most respondents (41%) rated restoring pre-injury function as very important, with a 95% CI of 37 and 45%, and a plurality (24%) ranked cost reduction as very important. The importance of physical changes was the lowest (7%; 95% CI, 5%-9%). Patient age, physical and mental health, and wealth were associated with preference variation, but there was no difference in the preference hierarchy between those who underwent limb salvage and those who underwent amputation. Injured patients at risk of losing a limb placed the highest emphasis on functional improvements and cost savings.
