Proefschrift

PWB insurgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities is cost effective 103 Introduction Annually, about 19% of patients who suffer a fracture have surgery because of peri- and/or intra-articular fractures of the lower extremities.1 These patients often suffer from sequelae and need long-term rehabilitation. The current postoperative management in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities is either non-weight bearing or restricted (or partial) weight bearing.2,3 According to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Principles of Fracture Management, postoperative management of peri- and/or intraarticular fractures of the lower extremities consist of non-weight bearing for 6-12 weeks, followed by partial weight bearing with a 25% increase in weight every week.2 Full weight bearing in this method will be reached per protocol after 10-16 weeks post-surgery, but in practice may take significantly more time.4,5 Both the current non-weight bearing postoperative management and the complications in trauma patients with peri- and/or intra-articular fractures of the lower extremities are often associated with a longer period of postoperative rehabilitation, and with lasting impairments. Moreover, estimates of medical costs and economic production losses to society due to trauma clearly warrant close attention from both health policy makers and the medical profession.6 The current non-weight bearing protocols are being disputed. Studies report positive effects e.g. less complications, reduced hospital stay, and a decrease in productivity loss due to an early or permissive weight bearing protocol.3,5-12 A recent study in surgically treated tibial plateau fractures found a 6 weeks shorter time to full weight bearing in the permissive weight bearing group (PWB) versus restricted weight bearing (RWB), 14.7 versus 20.7 weeks, respectively.5 However, despite the increasing importance of economic considerations in policy decision making, the costeffectiveness of PWB compared to RWB is yet unknown. Therefore, the aim of the present study was to compare the cost-effectiveness and the cost-utility of the PWB protocol with the RWB protocol from both a societal and a hospital perspective. Patients and methods This prospective comparative multicenter cohort study included surgically treated trauma patients with peri- and/or intra-articular fractures of the pelvis/acetabulum and the lower extremities. Subjects were consecutively recruited from six hospitals in the

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