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Unilateral Thumb Amputation: An Assessment of Utility Outcomes
Joshua Vorstenbosch1; Ali Izadpanah1; Arash Izadpanah2; Bernard T. Lee3; Samuel J. Lin4; Hani Sinno5
1McGill University Health Centre, Montreal, Canada; 2University of Manitoba, Manitoba, Canada; 3Beth Israel Deaconess Medical Center/Harvard University, Boston, MA; 4Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA; 5McGill University, Manitoba, Canada

Background: Unilateral thumb amputation causes significant morbidity in affected individuals, significantly compromising their capacity to perform tasks with the affected hand. Utility outcomes are powerful tools that have been used to objectively quantify the impact of several medical conditions on quality of life. In the present study, we measured the impact of unilateral thumb amputation on quality of life.
Methods: We used the visual analogue scale (VAS), time-trade off (TTO), and standard gamble (SG) techniques to measure the utility scores associated with unilateral thumb amputation, monocular blindness, and binocular blindness from prospective participants recruited online using Craigslist and the McGill Classifieds. Utility score data was compared using a paired t-test. Linear regression analysis was performed using age, gender, race, income, and education as independent predictors of the utility scores.
Results: 45 participants have been enrolled in our study to date and have met inclusion criteria. The utility outcome scores for unilateral thumb amputation (VAS, TTO, SG = 0.740.14, 0.900.13, 0.850.22) are significantly different when compared the scores assigned to monocular blindness (VAS, TTO, SG = 0.630.16, 0.870.14, 0.860.14) and binocular blindness (VAS, TTO, SG = 0.320.19, 0.660.26, 0.610.26). There was no difference in utility scores when assessed by linear regression based on gender, race, income or education.
Conclusions: We report here the utility outcomes score associated with unilateral thumb amputation (VAS, TTO, SG = 0.740.14, 0.900.13, 0.850.22), which is slightly less severe than monocular blindness, and comparable to severe breast hypertrophy and body contouring following massive weight loss. The population presented here would be willing to sacrifice 3.5 years of life or undergo a procedure such as thumb replantation or transplantation with a 15% chance of mortality to correct the amputated thumb.


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