Treatment Outcomes and Healthcare Resource Utilization In Computer Assisted Vacuum Thrombectomy versus Open Embolectomy: The THRIVE Study

To evaluate resource use among patients with lower extremity acute limb ischemia (LE-ALI) treated with computer-assisted vacuum thrombectomy (CAVT), embolectomy alone (EA) and embolectomy with adjunctive bypass (EAB) in the United States.

Materials and Methods:

This retrospective study utilized the Vizient Clinical Data Base¹ to identify adult (≥18 years) inpatients with LE-ALI discharged between 07/01/2020 and 09/30/2023. ICD-10 procedure codes and Medicare Severity Diagnosis Related Group (MS-DRG) were used to identify treatment groups. Propensity score matching (PSM) was performed at a 1:1:1 ratio based on demographics/comorbidities, payer and hospital type. Outcomes included hospital length of stay (LOS), post-procedure LOS (PPLOS), post-procedure intensive care unit days (PPICU) and discharge disposition.

Results:

873 CAVT patients were matched to EA and EAB patients, respectively. Baseline characteristics were similar between groups. The CAVT cohort included more white patients than all other groups and the EAB group held a higher Elixhauser Comorbidity Index (ECI) score compared to CAVT (5.2 vs 6.5, p= 0.0190). LOS for CAVT (5.3±4.4d) was significantly shorter than both EA (7.2±5.76d, p< 0.0001), and EAB (9.8±6.04d, p< 0.0001). Similarly, PPLOS was shorter for CAVT (4.1±4.09d) than EA (6.1±5.58d, p< 0.0001) and EAB (7.3±5.41d, p< 0.0001). No significant differences were observed in the proportion of patients requiring PPICU, with the observed mean PPICU stay remaining similar between all groups (range 0.7-0.8d). During the post-discharge period, CAVT was associated with the highest rate of home discharge (64.6%) compared to EA (44.4%, p< 0.0001) and EAB (36.9%, p< 0.0001), as well as the lowest rate of admission to skilled nursing facilities (SNF) (9.5%) compared to EA (15%, p= 0.0005) and EAB (20.5%, p< 0.0001). When discharged home, CAVT had significantly lower rates of home health support (18.3%) versus EA (28.9%, p< 0.0001) and EAB (31.7%, p< .0001). Following index hospitalization, EA (5.4%, p= 0.0034) and EAB (5.5%, p=: 0.0025) patients were both twice as likely as CAVT (2.6%) to require admission to a rehabilitation hospital.

Conclusion:

In this study, patients with LE-ALI treated with CAVT have significantly shorter LOS and PPLOS, and higher discharge rates to home compared to EA and EAB. Additionally, CAVT was associated with a reduced need for post discharge home health support, and admissions to SNF or rehabilitation hospitals.