Complex lower limb trauma and reconstructive surgery: understanding health service resource use

Abstract

Complex lower limb trauma is a challenging problem. Achieving optimal long-term outcomes requires multi-disciplinary input, while patients are in hospital, and after discharge. The aim of this study was to evaluate the long-term health services resource use of patients with such injuries, in the context of a publicly funded health system. This is a population-based retrospective cohort study. Data were obtained from the Information Services Division (ISD) Scotland. We included patients with isolated lower extremity injuries, sustained between 1997 and 2015, with follow-up to 2017. Cases were identified defined by ICD-10 and OPCS-4 procedural codes and divided into two groups, complex and simple injuries and analysed for their subsequent contacts with the health service. There were 42,601 patients with isolated lower limb injuries. 2976 (7.0%) had suffered complex injuries. The in-hospital mortality of these patients was 1.9%. 538 (18.1%) of the patients who sustained complex injuries underwent reconstructive surgery. Just over half attended an orthopaedic outpatient clinic in the first year, and 31.7% attended a plastic surgery clinic. Very few patients attended pain management clinics, or other clinics that might provide pain services. Only a small proportion of patients who undergo reconstructive surgery are followed up by specialist services. The reasons for such low follow-up rates are not obvious. Our findings raise the question of whether the health service in Scotland has sufficient resources to optimise functional outcome in this patient group. Level of evidence: Level III, risk / prognostic study