Amputation Versus Reconstruction in Traumatic Defects of the Leg: Outcome and Costs

Hertel, R.; N, Strebel; Ganz, Reinhold

doi:10.1097/00005131-199605000-00001

Cited by 116 publications

(98 citation statements)

References 14 publications

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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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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

View full text Add to dashboard Cite

show abstract

“…Ulcers are the most common skin problem clinically presented in people with lower-limb amputation [23], with the incidence of chronic or chronic-recurrent ulcers as high as 50 percent in people with traumatic lower-limb amputation [24]. When encountered on the residual limb, the standard of care for ulcers typically requires disuse of the prosthesis, which negatively affects rehabilitation efforts and quality of life for people with amputation.…”

Section: Discussionmentioning

confidence: 99%

Elevated vacuum suspension preserves residual-limb skin health in people with lower-limb amputation: Randomized clinical trial

et al. 2016

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Abstract-A growing number of clinical trials and case reports support qualitative claims that use of an elevated vacuum suspension (EVS) prosthesis improves residual-limb health on the basis of self-reported questionnaires, clinical outcomes scales, and wound closure studies. Here, we report first efforts to quantitatively assess residual-limb circulation in response to EVS. Residual-limb skin health and perfusion of people with lower-limb amputation (N = 10) were assessed during a randomized crossover study comparing EVS with nonelevated vacuum suspension (control) over a 32 wk period using noninvasive probes (transepidermal water loss, laser speckle imaging, transcutaneous oxygen measurement) and functional hyperspectral imaging approaches. Regardless of the suspension system, prosthesis donning decreased perfusion in the residual limb under resting conditions. After 16 wk of use, EVS improved residual-limb oxygenation during treadmill walking. Likewise, prosthesis-induced reactive hyperemia was attenuated with EVS following 16 wk of use. Skin barrier function was preserved with EVS but disrupted after control socket use. Taken together, outcomes suggest chronic EVS use improves perfusion and preserves skin barrier function in people with lower-limb amputation.Clinical Trial Registration: ClinicalTrials.gov; "Evaluation of limb health associated with a prosthetic vacuum socket system": NCT01839123; https://clinicaltrials.gov/ct2/show/ NCT01839123?term=NCT01839123&rank=1

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“…In previous studies, the largest cost burden with amputation is secondary to prosthesis maintenance [6,33,34,35]. Amputation compared to reconstruction surgery can have up to 3 times the cost over a patient's lifetime [33].…”

Section: Discussionmentioning

confidence: 99%

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

Naghavi

Gonzalez

Scott

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Adjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective.Material and methods: A retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months.Results: Median follow-up was 31 months. Staged reconstruction (n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR (n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005) and $58K higher with LF (p = 0.02).Conclusions: In recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

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Amputation Versus Reconstruction in Traumatic Defects of the Leg: Outcome and Costs

Cited by 116 publications

References 14 publications

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

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

Elevated vacuum suspension preserves residual-limb skin health in people with lower-limb amputation: Randomized clinical trial

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

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