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.