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Futility and Limb Salvage

Posted Sep 22 2008 10:37am

While most discussion regarding medical futility disputes centers around life-sustaining medical treatment, many other types of interventions may be medically inappropriate for the same or similar reasons. The stakes simply are not as high. For example, in the April 2008 issue of the American Surgeon, Spence Taylor discusses the "Current Status of Heroic Limb Salvage for Critical Limb Ischemia."

He notes that "critical limb ischemia ios a manifestation of systemic disease. As our population has aged we have learned that limb salvage surgery does little to thwart the ravages of spiraling poor health." The "original measure of procedural success, reconstruction patency, is a poor eventual predictor of functional outcome." Many patients (e.g. those with impaired ambulation, end-state renal disease) "might be better served with a primary amputation an no attempt at revascularization."

Therefore, Taylor argues, we must "redefine our goals of therapy to cost-effectively maximize the palliative benefit to the patient." Indeed, Taylor suspects that this redefinition may be "imposed by third party payers as our patient volume increases and our health care system continues to financially falter."

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