WINSTON-SALEM, N.C. – Patients with injuries that threaten their lower legs have similar outcomes whether they are treated by amputation or reconstructive surgery, according to a study by researchers from the Wake Forest University Baptist Medical Center and colleagues at seven other medical centers. The results are reported in this week’s New England Journal of Medicine.
“We believed that patients undergoing amputation would have better outcomes,” said Lawrence Webb, M.D., professor of orthopedics at Wake Forest. “These results are important because they will help us advise patients and their families who must make this treatment choice.” Webb was a co-investigator of the study.
The practice of treating severe leg injuries with reconstructive surgery was increasing at United States trauma centers, but until this study, a large-scale comparison of treatments had never been conducted. As a result of the findings, the research team suggests that reconstructive surgery should continue.
The investigators thought that patients treated by amputation would recover faster and return to their normal activities more quickly than those treated by multiple operations extending over the first year. After two years, however, the investigators found no differences in the measured outcomes between the groups. Both groups demonstrated severe levels of disability, low return to work rates, and high levels of psychological distress.
The researchers found, however, that patients who underwent reconstructive surgery had a higher risk of complications, additional surgeries, and rehospitalization.
Researchers enrolled 569 patients into the study from 1994 through 1997 and then evaluated them at multiple times over the two years following their injury. The patients’ injuries and treatments were documented and their recovery was evaluated using an extensive battery of outcome measures that included the Sickness Impact Profile (SIP), a patient-reported assessment of function in areas such as mobility, body care and movement, social interaction, alertness, emotional behavior, communication, sleep and rest, eating, work, home management and recreation. The SIP measures the impact of the injury as reported by the patient.
The researchers found that factors outside of the immediate control of the treating surgeon often significantly affected the patient’s recovery. These included the patient’s education and income level, lack of private health insurance, race, smoking, social support network, the patient’s confidence in his or her ability to resume usual activities post-injury, and involvement with the legal system for securing disability compensation.
While patients in the limb reconstruction group were more likely to require additional hospitalizations and surgical procedures, their results, at the two-year point, were equivalent to those obtained with amputation.
“Patients who have limb injuries that put them at a high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation,” said Webb.
Research was funded by a grant from the National Institute for Arthritis, Musculoskeletal and Skin Diseases of the National Institutes of Health.
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