Surgical treatment for chronic critical leg ischaemia: a 5 year follow-up of socioeconomic outcome.

OBJECTIVES

To evaluate the costs of amputation and arterial reconstruction for chronic critical leg ischaemia (CLI).

DESIGN

A 5 year follow-up study of patients with primary intervention for CLI.

SETTING

One regional and two district hospitals serving a defined population.

MATERIAL

One hundred and seventeen consecutive patients undergoing reconstructive arterial surgery or amputation for CLI.

CHIEF OUTCOME MEASURES

Additional procedures, treatment resources and costs related to the treatment of CLI.

MAIN RESULTS

Reconstruction patients needed frequent reinterventions due to graft problems, additional CLI symptoms and revisions of ischaemic tissue. The mean costs for a reconstruction were 240,000 FIM/patient and 70,000 FIM/survival year including costs for later amputations. Patients with a reconstruction without later amputation had costs of 175,000/ patient and 47,000/survival year. A reconstruction with a later amputation had the highest costs, 402,000/patient and 148,000/survival year. Contralateral leg ischaemia caused a new intervention in 25% of all patients. For non-institutionalised patients an amputation resulted in institutional treatment in over 20% of the remaining surviving days with a cost of 313,000 FIM/patient and 150,000 FIM/survival year. CLI in institutionalised patients with a primary amputation had a short stay in hospital, needed little additional resources and caused only low additional costs.

CONCLUSIONS

Costs for a reconstruction in potentially mobile, independently living patients with CLI is similar to those of an amputation. It often demands repeated interventions to achieve good results. On a cost/survival year basis, amputations carry higher costs. For institutionalised, immobile patients with CLI an amputation is often the only possible and cheapest treatment.