The cost of attempting limb salvage in patients who presented with acute lower limb ischaemia was recorded prospectively for 20 months. Seventy-five patients were admitted during the study; 45 were treated primarily by radiological intervention and 18 had primary surgery. The remainder were treated conservatively. Patients who had primary surgery required fewer visits to the operating theatre than those who had primary thrombolysis, but there was no difference in the total time that the theatre or radiology suite was occupied: median 2.3 (10th centile range 1.5-5.0) h and 3.0 (2.0-5.0) h respectively. Median (range) cost of disposables for performing surgery was &82 (58-169) and for thrombolysis was &407 (252-596). When the costs of using the theatre or radiology suite were included, the costs of both treatments were similar: surgery &683 (309-1438) and lysis &861 (611-1244). Median (10th centile range) inpatient stay for surgical patients was 9 (3-18) days and for those having thrombolysis 11 (2-29) days. Median (10th centile range) costs for bed occupancy were similar in both groups: surgery &2497 (643-9115) and lysis &2189 (902-6020). Mean cost for attempting limb salvage by surgery was 23429 (1094-10 065) compared with &3230 (1543-8353) for thrombolysis.
The advantage of thrombolysis compared with conventional catheter embolectomy or primary bypass appears to be a reduction in postoperative cardiorespiratory complications associated with surgery'. The outcome of thrombolysis, in terms of limb salvage, is comparable to that of surgery, but there is little information on the cost of the two treatments. To address this, the costs of primary thrombolysis and primary surgery in the management of acute arterial occlusion in a district general hospital were recorded prospectively for 20 months, at the same time as a multicentre randomized trial of high-dose bolus administration and low-dose infusion of tissue plasminogen activator (tPA) was in progress2.