Deficits in preference-based health-related quality of life after complications associated with tibial fracture

Author:

Gitajn I. L.1,Titus A. J.2,Tosteson A. N.3,Sprague S.4,Jeray K.5,Petrisor B.6,Swiontkowski M.7,Bhandari M.8,Slobogean G.9

Affiliation:

1. Department of Orthopaedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.

2. Department of Epidemiology, and Program in Quantitative Biomedical Sciences, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.

3. Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA and The Dartmouth Institute, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.

4. Division of Orthopaedic Surgery, Department of Surgery, and Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Canada.

5. Department of Orthopedic Surgery, Greenville Health System, Greenville, SC, USA.

6. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.

7. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.

8. Division of Orthopaedic Surgery, Department of Surgery, and Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.

9. Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Abstract

Aims The aims of this study were to quantify health state utility values (HSUVs) after a tibial fracture, investigate the effect of complications, to determine the trajectory in HSUVs that result in these differences and to quantify the quality-adjusted life years (QALYs) experienced by patients. Patients and Methods This is an analysis of 2138 tibial fractures enrolled in the Fluid Lavage of Open Wounds (FLOW) and Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) trials. Patients returned for follow-up at two and six weeks and three, six, nine and 12 months. Short-Form Six-Dimension (SF-6D) values were calculated and used to calculate QALYs. Results Compared with those who did not have a complication, those with a complication treated either nonoperatively or operatively had lower HSUVs at all times after two weeks. The HSUVs improved in all patients with the passage of time. However, they did not return to the remembered baseline preinjury values nor to US age-adjusted normal values by 12 months after the injury. Conclusion While the acute fracture and complications may have resolved clinically, the detrimental effect on a patient’s quality of life persists up to 12 months after the injury. Cite this article: Bone Joint J 2018;100-B:1227–33.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

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