Utility outcomes score assessment of living with below-knee amputation

Objectives: Lower limb trauma that involves severe soft-tissue injuries continues to pose treatment challenges when considering whether to perform an amputation or salvage the injured extremity. This study aimed to measure the perceived health burden of living with unilateral below-knee amputation (BKA). A secondary aim was to compare the health burden of living with BKA and single-eye blindness and/or double-eye blindness (SEB and DEB). Methods: A web-based survey was utilized to establish the effectiveness of outcome scores for three health states (unilateral BKA, SEB, and DEB) in a sample of 116 participants recruited from the general population. The outcome measures included the time trade-off (TTO), standard gamble (SG), and visual analog scale (VAS) tests. Results: The TTO, SG, and VAS scores for BKA were 0.75 ± 0.2, 0.78 ± 0.18, and 0.57 ± 0.16, respectively. These measures indicate that participants were willing to undergo a theoretical surgery that carries a 22% chance of mortality and trade 9 years of life to avoid a BKA. These were lower than the values of SEB VAS (P = 0.02) and TTO (P = 0.002) tests and the SG measure (0.8 ± 0.17, P = 0.09). Age, gender, race, income, and education were not statistically significant independent predictors of the utility scores for BKA. Conclusion: When faced with a BKA, individuals in our sample population would choose to undergo reconstructive surgery with a hypothetical 22% chance of mortality. They would be willing to sacrifice 9 years of their life for such a surgery to avoid a BKA. These data can be beneficial to understand better how patients perceive their disability and help in patients’ counseling.