<p>Analysis of the Peri-Operative Cost of Non-Traumatic Major Lower Extremity Amputation in Jordan</p>

Abstract

Purpose: Non-traumatic major lower extremity amputation (NMLEA) is a commonly performed procedure that presents a substantial cost burden. Patients who undergo NMLEA are usually considered as a high-risk group with significant comorbidities, which translates into a protracted peri-operative course and increased health-care costs. The primary aim of this study was therefore to perform a contemporary peri-operative cost analysis of NMLEA performed in our center. We are a major tertiary referral hospital that provides vascular surgery services to the entire northern counties in Jordan. We also aimed to assess the various factors that influence the cost of NMLEA in less economically developed countries. Methods: Records of all patients who underwent NMLEA at King Abdullah University Hospital between January 2012 and December 2017 were retrieved. Total inpatient cost was calculated and analyzed against different patients' variables. Results: A total of 140 patients underwent NMLEA between 2012 and 2017 in our facility. Below-knee amputations accounted for 110 cases, while above-knee amputations included 30 patients. Approximately two-thirds of the cases (61.4%) were males, with average age of the patients being approximately 62.9 years. The commonest comorbidities were diabetes mellitus and hypertension, which were recorded in 89.3% and 80.3% of the patients, respectively. The average operative time was 133.0 ± 10.8 mins, and the average length of stay (LOS) was 6.7±0.4 days. The mean cost for amputations was 4904.7± 429.3 United States dollars. Multiple linear regression analysis demonstrated that LOS and admission-to-operation time were the independent predictors of cost. Conclusion: Delayed amputations and prolonged LOS remain the most important determinants for the peri-operative cost of NMLEA. When amputation is deemed inevitable, an expedited multidisciplinary approach may possibly reduce undue delays and result in costeffective delivery of this age-old remedy.

Knowledge, attitude and perception towards lower limb amputation amongst persons living with diabetes in rural South Africa: A qualitative study

“…14 Lower limb amputation amongst persons with DM is associated with high risk for perioperative complications, prolonged length of stay in hospital, increased hospital costs and mortality. 15,16 Reported 30-day LLA-associated mortality rate ranges from 12% to 16% whilst annual mortality rate ranges from 43% to 48%. 16,17 The incidence of LLA can be mitigated through proper DM management, prompt identification and treatment of individuals at risk and patient self-management practices including foot care and examination.…”

“… 14 Lower limb amputation amongst persons with DM is associated with high risk for perioperative complications, prolonged length of stay in hospital, increased hospital costs and mortality. 15 , 16 Reported 30-day LLA-associated mortality rate ranges from 12% to 16% whilst annual mortality rate ranges from 43% to 48%. 16 , 17…”

Transmetatarsal amputations in patients with diabetes mellitus: A contemporary analysis from an academic tertiary referral centre in a developing community

“…Hospital length of stay (LOS) remains an important determinant of healthcare tariffs. A recent analysis of the perioperative cost of major LEA in Jordan identified that LOS remains the principal contributor to the final toll of major LEA [ 59 ]. In the United States, the cost of diabetic foot-related complications exceeds healthcare expenditure on the five most common cancers in the United States.…”

Multiple Prosthetic Sockets for Lower Limb Amputations

“…5,6 Care related to amputation, rehabilitation, and the long-term management of people with lower limb amputation is associated with significant use of health care resources. [6][7][8][9] Postoperative care that aims to maximize mobility, enables activities of daily living, and controls comorbid conditions is important to the rehabilitation process in people with lower limb amputation. 4,10 Once surgical wounds have sufficiently healed, it may be appropriate to initiate prosthesis fitting.…”