Cost factors in limb-threatening ischaemia due to infrainguinal arteriosclerosis

Cost factors are an increasingly important aspect of medical care. In the United States, more than 150,000 patients per year have limb-threatening ischaemia due to infrainguinal atherosclerosis. We studied the economic impact of this disease process and its treatment in 313 consecutive patients seen at our hospital between 1979 and 1981. Minimum follow-up was 3 years. Seventy-nine percent of our patients undergoing revascularisation attempts had limb salvage with full function at 1 year and 60% had full function at 3 years. Of the patients who died, 85% died with their limbs intact. The mean patient cost for all 289 arterial reconstructions was $26,194 +/- $876 S.E. ($23,026 +/- $1117 for 166 femoropopliteal bypasses; $30,380 +/- $1349 for 123 distal bypasses). The mean length of stay (LOS) for the reconstruction group was 50 days. In this patient population, the following adverse risk factors were present: Gangrene or necrosis in the foot (72%), age more than 70 (56%), and previous vascular surgery (21%). A significantly higher cost was associated with each of these factors (gangrene, $32,653 +/- $1534; age greater than 70, $28,089 +/- $1235; previous bypass, $29,666 +/- $1962). During the same time period, initial patient costs for 24 patients undergoing primary below-knee amputation and rehabilitation were $27,225 +/- $2896 S.E. Twenty-nine percent of the patients with below-knee amputations never walked again. The nonambulatory patients had a significant continuing expenditure for institutionalisation ($100/day) or home care ($270/week). These facts document the high cost of limb-threatening arteriosclerosis and its treatment by vascular reconstruction or primary below-knee amputation.(ABSTRACT TRUNCATED AT 250 WORDS)