ClinicoEconomics and Outcomes Research (Jan 2020)
Analysis of the Peri-Operative Cost of Non-Traumatic Major Lower Extremity Amputation in Jordan
Abstract
Qusai Aljarrah,1 Sohail Bakkar,2 Abdelwahab Aleshawi,3 Omar Al-Gharaibeh,3 Mooath Al-Jarrah,3 Radi Ebwayne,1 Mohammed Allouh,4 Ahmad K Abou-Foul5 1Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 2Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan; 3School of Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 4Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain 17666, United Arab Emirates; 5Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, St Mary’s Hospital, London W2 1NY, UKCorrespondence: Qusai AljarrahDepartment of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, JordanTel +962775593131Fax +96227200627Email [email protected]: 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 cost-effective delivery of this age-old remedy.Keywords: health care cost, amputation, ischemia, diabetic foot syndrome, length of stay
