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A Cost-Utility Analysis of Amputation versus Salvage for Gustilo Type IIIB and IIIC Open Tibial Fractures

Chung, Kevin C., M.D., M.S.; Saddawi-Konefka, Daniel, M.D., M.B.A.; Haase, Steven C., M.D.; Kaul, Gautam, Ph.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 1965-1973
doi: 10.1097/PRS.0b013e3181bcf156

Background: Lower extremity trauma is common. Despite an abundance of literature on severe injuries that can be treated with salvage or amputation, the appropriate management of these injuries remains uncertain. In this situation, a cost-utility analysis is an important tool in providing an evidence-based practice approach to guide treatment decisions.

Methods: Costs following amputation and salvage were derived from data presented in a study that emerged from the Lower Extremity Assessment Project. The authors extracted relevant data on projected lifetime costs and analyzed them to include discounting and sensitivity analysis by considering patient age. The utilities for the various health states (amputation or salvage, including possible complications) were measured previously using the standard gamble method and a decision tree simulation to determine quality-adjusted life-years.

Results: Amputation is more expensive than salvage, independently of varied ongoing prosthesis needs, discount rate, and patient age at presentation. Moreover, amputation yields fewer quality-adjusted life-years than salvage. Salvage is deemed the dominant, cost-saving strategy.

Conclusion: Unless the injury is so severe that salvage is not a possibility, based on this economic model, surgeons should consider limb salvage, which will yield lower costs and higher utility when compared with amputation.

Ann Arbor, Mich.

From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the University of Michigan Medical School; and the University of Michigan’s Stephen M. Ross School of Business.

Received for publication April 13, 2009; accepted June 18, 2009.

Disclosure:None of the authors has a financial interest to declare in relation to the content of this article.

Kevin C. Chung, M.D., M.S., Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-5340,

©2009American Society of Plastic Surgeons