Proefschrift

Economic burden of the postoperative management in peri- and/or intra-articular fractures of the lower extremities 37 Introduction Every year, millions of people with a fracture of the lower extremities are treated in emergency rooms all over the world.1 In the Netherlands, approximately 15,000 trauma patients undergo surgery because of peri- and/or intra-articular fractures of the lower extremity.2,3 The standard aftercare treatment in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities features either non-weight bearing or partial weight bearing.4 According to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Principles of Fracture Management, postoperative management of peri- and/or intra-articular fractures of the lower extremities consists of non-weight bearing for 6-12 weeks, followed by partial weight bearing with a 25% increase in fracture loading every week.5 Full weight bearing in this method will be reached generally 10-16 weeks post-surgery. Recent studies based on protocols using the existing non-weight bearing guidelines have reported composite postoperative complication rates of up to 37% with an average of 10-20% in patients with lower extremity fractures.6-15 The complications in trauma patients with peri- and/or intra-articular fractures of the lower extremities have a significant impact on the period of postoperative rehabilitation, suggesting substantial direct health-care costs and economic burden to the society. However, to our knowledge, no study has yet been done regarding the cost-of-illness (CoI) in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities. Insight into the estimation of the economic burden could help to raise awareness in policy makers about the disease and provide relevant information for economic evaluations in the future. The aim of this study was to determine the costs and QoL changes in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities over a 26 weeks period. The medical ethics committee of Maastricht University Medical Center, Maastricht, the Netherlands, approved this study, reference number: METC 16–4-236. Patient’s informed consent to participate was obtained from all patients. Patients and methods This prospective multicenter cohort study included surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities. Patients were recruited from 4 hospitals in the Netherlands (i.e Catharina Hospital, Eindhoven;

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