Proefschrift

Chapter 4 44 and unpaid, despite their fracture, reducing productivity losses. Second, the group of patients without paid job were significantly older, and had significantly more comorbidity than the patients with a paid job, which could explain the increased need of care during rehabilitation. The treatment as usual regarding postoperative management is 6-12 weeks nonweight bearing.5 This protocol is unchanged for 60 years and not based on evidencebased medicine.5 Recent studies have added evidence in support of the use of an early or permissive weight bearing protocol.4,28,29 According to the present study, the healthcare costs together with the productivity losses represent the majority of the total costs. These costs could be due to the period of non-weight bearing. Recent studies have shown that early or permissive weight bearing might shorten the period of postoperative management,4,28,30 and therefore reduce the postoperative costs. However, to our knowledge, there are no studies done investigating the Cost-of-illness nor the cost-effectiveness in surgically treated trauma patients with peri- and/or intraarticular fractures of the lower extremities following different postoperative management. Therefore, we have started a prospective comparative cohort study in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities to address these mitigations.16 There was a significant clinical improvement in ADL as measured with the LEFS in this study. In our population, the mean LEFS, 26 weeks post-surgery, was 49.5. This is in line with two studies which also reported a significant improvement in ADL in trauma patients after surgery.30,31 Furthermore, there was a significant improvement in quality of life between first measurement and week 6 as measured with the EuroQol. Besides, the utility changes in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities haven’t been described before. Therefore, this makes it more difficult to compare the utility changes with previous studies. Recent literature has reported composite postoperative complication rates of up to 37%, with an average of 10–20% in patients with lower extremity fractures (6–15). Comparing our complication data with data published in recent literature, we found comparable rates of postoperative complication (20.8% (N=11/N=53)). The mean overall costs in patients with complications was € 2,031.75 higher than patient without complications. We assume that the increase of the overall costs in patients with complications are representative. However, no literature regarding the costs in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities having complications is available. This study provides the first recent report on utility outcomes in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities.

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