Costly surgical procedures to save a patient’s limb which otherwise could be amputated may ultimately prove cheaper over the long term, according to a new medical study.
Research by staff from University Hospital Limerick and the University of Limerick claims expensive surgery to restore blood flow to arms and legs is likely to be significantly cheaper once the length of hospital stays and prosthetic limbs for amputees are considered.
The study found patients who had limbs amputated were required to spend 2.8 times longer in hospital than those treated by revascularisation – surgery which restores blood flow to blocked arteries or veins – while the associated costs were 1.3 times higher.
The report noted that loss of an arm or leg is a life-changing event with immeasurable cost to the individual, while the potential financial benefit of saving a limb is not well documented.
The incidence of chronic limb-threatening ischemia (CLTI) where there is a severe lack of blood flow to the hands, legs or feet and is growing globally due to an ageing population and increasing prevalence of diabetes.
Patients with CLTI are usually treated either by amputation or revascularisation with the decision based on the individual’s fitness, risk, extent of the disease and its anatomical pattern.
The study analysed 124 patients who were admitted to UHL between March 2022 and March 2023 for surgical treatment for CLTI.
It noted that a standard framework provides the optimum pathway for the treatment of patients that have potential for revascularisation with amputation of lower limbs usually only chosen as a last resort or if the patient is deemed bedbound.
The results show that 109 patients underwent revascularisation, while 27 had a limb amputated including 12 who had previously had a revascularisation procedure within the study period.
They revealed there was a statistically significant difference in the cost of amputation which averaged €2,064 compared to the cost of a revascularisation intervention which ranged from €3,384 to €5,966, depending on the type of procedure.
However, there was also a statistically significant difference between the two treatments in terms of the cost of length of stay.
The study found the median length of stay for patients who had a limb amputated was 29 days, while the comparable period for those who had a revascularisation procedure was 5-10.5 days.
The associated median cost of a stay in hospital for an amputee was €61,313 but ranged from €16,823 to €46,573 for those who had some form of revascularisation procedure.
However, the cost for patients who had a limb amputated rose even further to €88,820 once the cost of a prosthetic limb and rehabilitation were included.
While the cost of revascularisation procedures is rising rapidly due to evolving technologies, the study pointed out that post-amputation rehabilitation remains constrained by limited dedicated specialist rehabilitation beds and a significant waiting list for services provided by the National Rehabilitation Hospital.
The researchers said awareness of all inputs including costs helped healthcare professionals to comprehend and quantify the resources required to effectively treat patients.
The study concluded: “While it would be exceedingly difficult to estimate the cost of limb loss to the individual and to society in general, it would seem a timely reminder that the cost of bed days alone makes efforts to save limbs through revascularisation very worthwhile.”
The findings, which are published in the Irish Journal of Medical Science, also revealed that most patients were males over the age of 65, while approximately 40 per cent had diabetes.
Almost 60 per cent of amputees were smokers or ex-smokers.
More than 8 out of 10 amputees had previously had some form of revascularisation procedure.
The figures showed a mortality rate of 10 per cent among those patients who had successful revascularisation and 15 per cent among those who had a major limb amputation.
