Health-Care Costs Associated with Amputation or Reconstruction of a Limb-Threatening Injury

MacKenzie, Ellen J.; Jones, Alison Snow; Bosse, Michael J.; Castillo, Renan C.; Pollak, Andrew N.; Webb, Lawrence X.; Swiontkowski, Marc F.; Kellam, James F; Smith, Douglas G.; Sanders, Roy; Jones, Alan L.; Starr, Adam J.; McAndrew, Mark P.; Patterson, Brendan M.; Burgess, Andrew R.

doi:10.2106/jbjs.f.01350

Cited by 262 publications

(161 citation statements)

References 9 publications

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“…When compared with prior epidemiologic studies of traumatic amputations, the current study reinforces a previous finding that LEAs most frequently occur in pedestrians struck by vehicles [8][9][10]. This association is likely due to the vehicle contact with the lower extremity.…”

Section: Discussionsupporting

confidence: 85%

Traumatic limb amputations at a level I trauma center

Kobayashi

Inaba

Barmparas

et al. 2010

Eur J Trauma Emerg Surg

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Traumatic limb amputation is a rare consequence of civilian trauma. Amputation is rarely the primary cause of death; however, these devastating injuries are associated with significant intensive care unit and hospital lengths of stay. Although no mortality difference was detected, when compared with patients with upper extremity amputations, patients with lower extremity amputations were more severely injured, required revision extremity surgery more often, had a higher complication rate, and more frequently required discharge to a long-term facility.

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Section: Discussionsupporting

confidence: 85%

Traumatic limb amputations at a level I trauma center

Kobayashi

Inaba

Barmparas

et al. 2010

Eur J Trauma Emerg Surg

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“…The outcome scores used in this study are validated and reliably measure function [3,30], disability, and mental health in a variety of diseases. These scores have been used by the LEAP investigators [5,7,[22][23][24][25][26], facilitating comparison with our results. This small cohort involved variable demographics, and had a broad range of injuries encompassing multiple different skeletal and soft tissue procedures.…”

Section: Discussionmentioning

confidence: 99%

Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Merwe

Birkholtz

Tetsworth

et al. 2016

Injury

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Purpose:The purpose of this study was to evaluate the functional and psychological outcomes of patients who underwent delayed lower limb amputation following failed limb salvage surgery. Methods:This retrospective, descriptive study evaluated functional outcomes using the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) in 12 patients. Inclusion criteria included patients who underwent limb reconstruction and delayed amputation between between July 2006 and December 2014, with an age range between 18-80 years of age, the ability to ambulate independently, a time interval between the last salvage procedure and amputation greater than six months, and a minimum follow-up of 24 months. Patients were contacted via telephone by the principal investigator and both the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) were completed. Descriptive analysis (means and standard deviation) was used to determine outcomes for both SIP and SF-36 health profiles. Results:Ten patients who had amputations following failed reconstruction (2006-2014) with a mean age of 53+10 years were interviewed. Six patients had a SIP < 5, three patients scored between five and 10 points and one scored >10 points. The main deficit on the SF-36 was in the physical component. The SF-36 scores demonstrated a mean score of 40.8+11.5 for the physical component, and 57.4+7.9 for the mental component. Three patients returned to work after amputation and continued performing their pre-injury duties as farmers.Three other patients returned to work, but were allocated to administrative duties. Two patients were pensioners at the time of their injuries, and the only female patient was a housewife. One patient went into early retirement. Conclusion:The results of this study strongly suggest that delayed amputation following failed limb salvage surgery can still result in good and satisfactory outcomes in the majority of patients and achieves results similar to early amputation and limb reconstruction techniques.

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“…† Previous literature evaluating costs in patients with limb loss focused on healthcare costs of different surgical procedures (such as immediate or delayed amputations [6], surgical reconstruction, and amputation [7][8]) or costs of different types of prosthetic devices [9][10]. No published research has projected lifetime costs incorporating the diverse combinations of prosthetic devices in current use today.…”

Section: Introductionmentioning

confidence: 99%

Prosthetic cost projections for servicemembers with major limb loss from Vietnam and OIF/OEF

Blough

Hubbard

McFarland

et al. 2010

JRRD

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Abstract-This study projects prosthetic-and assistive-device costs for veterans with limb loss from Vietnam and injured servicemembers returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) to inform the Department of Veterans Affairs (VA) for these veterans' future care. The 2005 Medicare prosthetic device component prices were applied to current prosthetic and assistive-device use obtained from a national survey of 581 veterans and servicemembers with major traumatic amputations. Projections were made for 5-year, 10-year, 20-year, and lifetime costs based on eight Markov models. Average 5-year projected costs for prosthetic and assistivedevice replacement for the Vietnam group are lower than for the OIF/OEF cohort due in part to use of fewer and less technologically advanced prosthetic devices and higher frequency of prosthetic abandonment. By limb-loss level, for the Vietnam group and OIF/OEF cohort, 5-year projected unilateral upper limb average costs are $31,129 and $117,440, unilateral lower limb costs are $82,251 and $228,665, and multiple limb costs are $130,890 and $453,696, respectively. These figures provide the VA with a funding estimate for technologically advanced prosthetic and assistive devices within the framework of ongoing rehabilitation for veterans with traumatic limb loss from the Vietnam and OIF/OEF conflicts.

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Health-Care Costs Associated with Amputation or Reconstruction of a Limb-Threatening Injury

Abstract: These estimates add support to previous conclusions that efforts to improve the rate of successful reconstructions have merit. Not only is reconstruction a reasonable goal at an experienced level-I trauma center, it results in lower lifetime costs.

Cited by 262 publications

References 9 publications

Traumatic limb amputations at a level I trauma center

Traumatic limb amputations at a level I trauma center

Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Prosthetic cost projections for servicemembers with major limb loss from Vietnam and OIF/OEF

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