title: Cost of treating advanced leg ischemia. Bypass graft vs primary amputation.
abstract: 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.
authors.affiliation: Vascular Surgery Section, UCLA School of Medicine.
authors.forename: C A
authors.initials: CA
authors.lastname: Raviola
authors.forename: L S
authors.initials: LS
authors.lastname: Nichter
authors.forename: J D
authors.initials: JD
authors.lastname: Baker
authors.forename: R W
authors.initials: RW
authors.lastname: Busuttil
authors.forename: H I
authors.initials: HI
authors.lastname: Machleder
authors.forename: W S
authors.initials: WS
authors.lastname: Moore
mesh_terms: D000671:Amputation, Surgical / Q000191:economics* / Q000534:rehabilitation; D001158:Arteries / Q000601:surgery*; D002140:California; D003365:Costs and Cost Analysis; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007511:Ischemia / Q000191:economics* / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D007902:Length of Stay; D013223:Statistics as Topic; D013673:Technology Assessment, Biomedical / Q000191:economics*