17. Healthcare Costs Associated with Major Upper Extremity Amputations in Ontario: A Retrospective Matched Cohort Study
Bibliographic record
Abstract
Introduction: Major upper extremity loss, defined as amputation above the wrist, has a significant impact on patients’ activities of daily living. Causes of upper extremity loss include trauma, malignancy, diabetes mellitus, vascular diseases, and infections. Upper extremity loss can have a profound impact on patients and impose considerable financial burden on patients and the healthcare system. While standard of care has been prosthetics, vascularized composite allotransplantation (VCA) offers an alternative, sophisticated, reconstructive solution with improved functionality and quality of life. Little is known about the healthcare costs associated with major upper extremity amputations. A 2016 study projects cost of unilateral hand VCA to be $735,647 CAD and bilateral hand VCA to be $747,837 CAD. Our matched retrospective cohort study spanning 20 years aims to compares standard of care costs to reported estimates of VCA cost. Methods: We conducted a matched retrospective cohort study of patients who underwent major upper extremity amputations between April 1, 2002 and March 31, 2023, ensuring a minimum 1-year follow-up for most recent cases. Patients were matched with general population and hospital-based trauma controls. Healthcare use and costs were analyzed by follow-up duration (<1 year, 1-4 years, 5-9 years, >10 years), and compared to projected VCA costs. Results: We identified 617 patients with a mean follow-up of 6.95 years (SD 6.16). Traumatic etiologies accounted for 41.7% of amputations, whilst non-traumatic etiologies accounted for 58.3%. Most amputations were unilateral (85.3%), while 3.2% were bilateral, and 11.5% were unidentifiable from our databases. The forearm was the most common amputation level (42.9%). Costs were determined to be $52,661 CAD (IQR: 22,009–120,120) for traumatic and $90,928 CAD (IQR: 43,128–213,034) for non-traumatic cases. Bilateral amputations incurred higher costs: $104,895 CAD (IQR: 41,290–243,967) for traumatic and $117,006 CAD (IQR: 68,447–226,491) for non-traumatic cases, excluding prosthetics. Conclusions: This study is the first to examine healthcare use and cost of major upper extremity amputations in Ontario, Canada. Our assistive devices program registry indicates that 47.9% of trauma patients apply for limb replacement, but have high abandonment rates due to function. The 30-year cost for unilateral amputee myoelectric devices is $171,860 CAD, while for bilateral amputees, costs are $344,895 CAD. Major upper extremity loss imposes substantial financial burden on the healthcare system when compared to the general population and other trauma cohorts. While the 30-year projection of VCA costs by Health Quality Ontario exceeds that of prosthetic devices, VCA may provide a life-enhancing option, particularly for bilateral amputees. Further studies assessing healthcare costs associated with VCA are required as patient cohort sample size grows.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".