Fix or Replace? Patient Preferences for the Treatment of Geriatric Lower Extremity Fractures: A Discrete Choice Experiment

John T Richards; Nathan N O'Hara; Kathleen Healy; Nicolas Zingas; Natasha McKibben; Caroline Benzel; Gerard P Slobogean; Robert V O'Toole; Marcus F Sciadini

doi:10.1177/21514593241236647

Fix or Replace? Patient Preferences for the Treatment of Geriatric Lower Extremity Fractures: A Discrete Choice Experiment

Geriatr Orthop Surg Rehabil. 2024 Feb 28:15:21514593241236647. doi: 10.1177/21514593241236647. eCollection 2024.

Authors

John T Richards^{1

2}, Nathan N O'Hara^{1

2}, Kathleen Healy^{1

2}, Nicolas Zingas^{1

2}, Natasha McKibben^{1

2}, Caroline Benzel^{1

2}, Gerard P Slobogean^{1

2}, Robert V O'Toole^{1

2}, Marcus F Sciadini^{1

2}

Affiliations

¹ Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
² Author's name insert query plzJ. T. Richards is an employee of the US Government. This work was prepared as part of their official duties. Title 17 U.S.C.§105 provides that "Copyright protection under this title is not available for any work of the United States Government." Title 17 U.S.C. §101 defined a US Government work as a work prepared by a military service member or employees of the US Government as part of that person's official duties. The opinions or assertions contained in this paper are the private views of the authors and are not to be construed as reflecting the views, policy or positions of the Department of the Navy, Department of Defense nor the US Government.

Abstract

Introduction: When considering treatment options for geriatric patients with lower extremity fractures, little is known about which outcomes are prioritized by patients. This study aimed to determine the patient preferences for outcomes after a geriatric lower extremity fracture.

Materials and methods: We administered a discrete choice experiment survey to 150 patients who were at least 60 years of age and treated for a lower extremity fracture at a Level I trauma center. The discrete choice experiment presented study participants with 8 sets of hypothetical outcome comparisons, including joint preservation (yes or no), risk of reoperation at 6 months and 24 months, postoperative weightbearing status, disposition, and function as measured by return to baseline walking distance. We estimated the relative importance of these potential outcomes using multinomial logit modeling.

Results: The strongest patient preference was for maintained function after treatment (59%, P < .001), followed by reoperation within 6 months (12%, P < .001). Although patients generally favored joint preservation, patients were willing to change their preference in favor of joint replacement if it increased function (walking distance) by 13% (SE, 66%). Reducing the short-term reoperation risk (12%, P < .001) was more important to patients than reducing long-term reoperation risk (4%, P = .33). Disposition and weightbearing status were lesser priorities to patients (9%, P < .001 and 7%, P < .001, respectively).

Discussion: After a lower extremity fracture, geriatric patients prioritized maintained walking function. Avoiding short-term reoperation was more important than avoiding long-term reoperation. Joint preservation through fracture fixation was the preferred treatment of geriatric patients unless arthroplasty or arthrodesis provides a meaningful functional benefit. Hospital disposition and postoperative weightbearing status were less important to patients than the other included outcomes.

Conclusions: Geriatric patients strongly prioritize function over other outcomes after a lower extremity fracture.

Keywords: adult reconstructive surgery; foot and ankle surgery; geriatric medicine; geriatric trauma; trauma surgery.

Grants and funding

K24 AR076445/AR/NIAMS NIH HHS/United States