Cost of Treating Advanced Leg Ischemia

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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 $20300, compared with $14000 for uncomplicated below-knee amputation. However, including the cost of prosthesis and rehabilitation, the total cost of primary amputation was $20400, 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 $28700; complications that ended with major amputation added 15 hospitalization days and had an average cost of $42200. In contrast, complicated below-knee amputation cost $40600 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. (Arch Surg 1988;123:495-496)

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