Amputation versus reconstruction in traumatic defects of the leg : Outcome and costs.
This retrospective review covers global aspects of reconstructive efforts to salvage severely injured legs.
Eighteen patients with traumatic lower leg amputation were compared to 21 patients who underwent complex microvascular reconstruction.
The mean number of interventions was 3.5 for amputation and 8 for reconstruction (p<0.009).
Total rehabilitation time was 12 months for amputation and 30 months for reconstruction (p<0.009).
Changes in lifestyle were consistently more important in the amputee group.
The mean annual hospital costs for amputated patients were 15'112 Swiss Francs (SD 7'094SF) for the first 4 years.
The mean annual hospital costs for reconstructed patients were 17'365 Swiss Francs (SD 8'702SF) for the first 4 years.
Fifty-six percent of the amputees and 19% of the reconstructed patients were retrained to a different profession (p<0.025).
Fifty-four percent of the amputees and 16% of the reconstructed patients were drawing an extremely costly and lifelong invalidity pension (p<0.02).
We conclude that for potentially salvageable legs reconstruction is advisable because the functional outcome was better than for amputation and there was no permanent social disintegration due to the long treatment.
Total costs (including pensions) for reconstruction were far lower than for amputation.
Mots-clés Pascal : Fracture ouverte, Jambe, Homme, Pronostic, Efficacité traitement, Analyse coût, Economie santé, Etude comparative, Plastie, Amputation chirurgicale, Capacité fonctionnelle, Tibia, Ostéosynthèse, Fixation, Os, Membre inférieur, Traumatisme, Système ostéoarticulaire pathologie, Peau pathologie, Chirurgie orthopédique
Mots-clés Pascal anglais : Open fracture, Leg, Human, Prognosis, Treatment efficiency, Cost analysis, Health economy, Comparative study, Plasty, Surgical amputation, Functional capacity, Tibia, Osteosynthesis, Fixation, Bone, Lower limb, Trauma, Diseases of the osteoarticular system, Skin disease, Orthopedic surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0253003
Code Inist : 002B16H. Création : 199608.