An Analysis Of Trends In Lower Extremity Trauma Management:Is Lower Extremity Reconstruction A Thing Of The Past?
Jack C. Burns, M.D., Ryan C. DeCoster, M.D., Daniel L. Davenport, Ph.D., Henry C. Vasconez, M.D..
University of Kentucky, Lexington, KY, USA.
PURPOSE: Over the last decade, advancements have been made in prosthetics for patients suffering lower extremity trauma requiring amputation. As no good algorithms exist to guide clinical judgment of limb reconstruction versus amputation, it is postulated advances in prosthetic technology have led surgeons to increasingly favor amputations. The primary outcome of this study was to determine trends in lower extremity trauma management. Secondary outcomes included cost analysis and healthcare resource utilization.METHODS: A retrospective cohort study was conducted at the authors' institution in patients with lower extremity trauma from 2005-2014. In total, 151 patients were identified that met inclusion criteria. Patients were subdivided into amputation (n=69) and reconstruction (n=82) groups. Spearman's rank correlation coefficient (rho) compared amputation and reconstruction groups. Costs and healthcare utilization data were analyzed using Mann-Whitney U, chi-square, and Fisher's Exact analyses.RESULTS: Amputation was performed more frequently over time (See Table). The amputation group had higher one year costs following initial trauma (p<0.001). Furthermore, this group had additional hospital encounters (p<0.001), ambulatory clinic visits (p<0.001), inpatient visits (p<0.001), and outpatient surgeries (p<0.019) during the same period. CONCLUSION: This trend towards amputation suggests a shift in management of lower extremity trauma, yet amputation is associated with higher costs and resource utilization. Therefore, economics alone cannot explain this trend. Perhaps improved prosthetic technology has led to improved functional outcomes, thus explaining increased amputations.
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