OPERATIONS, TOTAL HOSPITAL STAY AND COSTS OF CRITICAL LEG ISCHEMIA - A POPULATION-BASED LONGITUDINAL OUTCOME STUDY OF 321 PATIENTS

In a longitudinal analysis of all 321 patients in a defined population having surgery for critical leg ischemia during 1 year in Malmohus co unty (0.53 million inhabitants), Sweden, we investigated all vascular procedures and amputations on both legs, total hospital stay and hospi tal costs from the first procedure in each patient until death or at f ollow-up at least 6 years postoperatively. The first (key) operation d uring the inclusion year was a reconstructive vascular procedure in 96 patients, a restorative vascular procedure in 111 and a major amputat ion in 114 patients. One third of those with a reconstructive and half of those with a restorative key procedure had an ipsilateral major am putation. The mean number of surgical procedures and length of hospita l stay among all patients were 3 (1-19) procedures and 117 (1-1097) da ys, respectively, Of the total number of days in hospital, less than h alf were in surgical departments, 10% in other acute-care departments and almost half in rehabilitation clinics and nursing homes. The total hospital and surgical costs among all patients were USD 15.1 million (mean USD 47,000/patient), with no significant differences in relation to the key operation. We conclude that patients who have undergone su rgery for critical leg ischemia accumulate very high total long-term h ospital costs due to the need for repetitive surgery and long hospital stays. Our findings also show that a longitudinal study, including ho spital stay in departments other than surgical, is necessary for a cor rect cost-and-outcome analysis.