Patient preferences for operative versus nonoperative treatment of LC1 pelvis fracture: a discrete choice experiment

Abstract

OBJECTIVE: To quantify how patients with LC1 pelvis fracture value attributes of operative versus nonoperative treatment. METHODS: Design: Discrete choice experiment. Setting: 3 US Level 1 trauma centers. Patient Selection Criteria: Adult survivors of an LC1 pelvis treated between June 2016 through March 2023 were identified from institutional registries. The choice experiment was administered as a survey from March through August 2023. Outcome Measures and Comparisons: Participants chose between 12 hypothetical comparisons of treatment attributes including operative or nonoperative care, risk of death, severity of pain, risk of secondary surgery, shorter hospital stay, discharge destination, and independence in ambulation within one month of injury. The marginal utility of each treatment attribute, e.g. the strength of participants’ aggregate preference for an attribute as indicated by their survey choices, was estimated by multinomial logit modeling with and without stratification by treatment received. RESULTS: 449 eligible patients were identified. The survey was distributed to 182 patients and collected from 72 (39%) patients at a median 2.3 years after injury. Respondents were 66% female with a median age of 59 years (IQR 34-69). Before injury, 94% ambulated independently and 75% were working. 41% received operative treatment. Independence with ambulation provided the highest relative marginal utility (21%, p<0.001), followed by discharge to home versus skilled nursing (20%, p<0.001), moderate versus severe post-discharge pain (17%, p<0.001), shorter hospital stay (16%, p<0.001), secondary surgery (15%, p<0.001), mortality (10%, p=0.02). Overall, no relative utility for operative versus nonoperative treatment was observed (2%, p=0.54). However, respondents strongly preferred the treatment they received: operative patients valued operative treatment (utility, 0.37 vs. -0.37, p<0.001); nonoperative patients valued nonoperative treatment (utility, 0.19 vs. -0.19, p<0.001). CONCLUSIONS: LC1 pelvis fracture patients valued independence with ambulation, shorter hospital stay, and avoiding secondary surgery and mortality in the month after their injury. Patients preferred the treatment they received rather than operative versus nonoperative care. LEVEL OF EVIDENCE: Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.