SURGICAL-TREATMENT FOR CHRONIC CRITICAL LEG ISCHEMIA - A 5-YEAR FOLLOW-UP OF SOCIOECONOMIC OUTCOME

Objectives: To evaluate the costs of amputation and arterial reconstru ction for chronic critical leg ischaemia (CLI). Design: A 5 year follo w-up study of patients with primary intervention for CLI. Setting: One regional and two district hospitals serving a defined population.Mate rial: One hundred and seventeen consecutive patients undergoing recons tructive arterial surgery or amputation for CLI. Chief outcome measure s: Additional procedures, treatment resources and costs related to the treatment of CLI. Main results: Reconstruction patients needed freque nt reinterventions due to graft problems, additional CLI symptoms and revisions of ischaemic tissue. The mean costs for a reconstruction wer e 240 000 FIM/patient and 70 000 FIM/survival year including costs for later amputations. Patients with a reconstruction without later amput ation had costs of 175 000/patient and 47 000/survival year. A reconst ruction with a later amputation had the highest costs, 402 000/patient and 148 000/survival year. Contralateral leg ischaemia mused a new in tervention in 25% bf all patients. For non-institutionalised patients an amputation resulted in institutional treatment in over 20% of the r emaining surviving days with a cost of 313 000 FIM/patient and 150 000 FIM/survival year. CLI in institutionalised patients with it primary amputation had a short stay in hospital, needed little additional reso urces and caused only low additional costs. Conclusions: Costs for a r econstruction in potentially mobile, independently living patients wit h 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 patien ts with CLI an amputation is open the only possible and cheapest treat ment.