Cost of treating advanced leg ischemia. Bypass graft vs primary amputation
C. A. Raviola, L. S. Nichter, J. D. Baker, R. W. Busuttil, H. I. Machleder and W. S. Moore
Vascular Surgery Section, UCLA School of Medicine.
We compared the hospital costs of 94 patients undergoing femoropopliteal
bypass grafts with those of 53 patients undergoing primary amputation. The
total cost of uncomplicated bypass surgery averaged +20,300, compared with
+14,000 for uncomplicated below-knee amputation. However, including the
cost of prosthesis and rehabilitation, the total cost of primary amputation
was +20,400, equivalent to that of the bypass operation. Complications
requiring revision of a bypass graft increased hospitalization by 4.5 days
with the total cost rising to +28,700; complications that ended with major
amputation added 15 hospitalization days and had an average cost of
+42,200. In contrast, complicated below-knee amputation cost +40,600 and
added 12.5 hospitalization days. There is therefore no cost-benefit in
primary amputation when compared with arterial reconstruction, and cost
should not be used to deny a patient the opportunity for limb salvage.