Raviola C A, Nichter L S, Baker J D, Busuttil R W, Machleder H I, Moore W S
Vascular Surgery Section, UCLA School of Medicine.
Arch Surg. 1988 Apr;123(4):495-6. doi: 10.1001/archsurg.1988.01400280105021.
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.
我们比较了94例行股腘动脉搭桥术患者与53例行一期截肢术患者的住院费用。单纯搭桥手术的总费用平均为20300美元，而单纯膝下截肢术的费用为14000美元。然而，包括假肢和康复费用在内，一期截肢术的总费用为20400美元，与搭桥手术相当。需要翻修搭桥移植物的并发症使住院时间增加4.5天，总费用升至28700美元；以大截肢告终的并发症使住院时间增加15天，平均费用为42200美元。相比之下，复杂的膝下截肢术费用为40600美元，住院时间增加12.5天。因此，与动脉重建相比，一期截肢术没有成本效益，不应因费用问题而剥夺患者肢体挽救的机会。
