160 - Resource Utilization Differences Between Aspiration Thrombectomy and Open Embolectomy in Lower Extremity Acute Limb Ischemia (LE-ALI): A U.S. Nationwide Cohort Study

Purpose: To compare resource use among patients with LE-ALI managed with aspiration thrombectomy, using computer-assisted vacuum thrombectomy (CAVT), or open embolectomy (OE) in the United States

Materials and Methods: This nationwide study used the Premier Healthcare Database to identify adult (≥ 40 years) inpatients with a principal or secondary diagnosis of LE-ALI discharged between 01/01/2021 – 06/30/2024. ICD-10 procedure codes identified therapy groups. Patients undergoing both CAVT and OE were excluded. Outcomes included length of stay (LOS), post-procedure LOS (PPLOS), intensive care unit stay (ICU), post-procedure ICU (PPICU), post-procedure step-down unit use, in-hospital mortality, discharge status, and 30-day all cause and ALI related readmissions. Multivarible regression models adjusted for patient/hospital factors and reported odds ratios (OR) and LOS ratios (LOSR) with 95% confidence intervals (CIs).

Results: A total of 9,243 patients were identified. Of these, 1,332 were managed with CAVT and 7,911 with OE. After adjustment, CAVT was associated with a 35% reduction in mean LOS (2.33 days shorter) (LOSR 0.65, 95% CI 0.62-0.68; p< 0.001) and a 41% a reduction in mean PPLOS (2.27 days shorter) (LOSR 0.59, 95% CI 0.56-0.62; p< 0.001). While there was no difference in overall ICU admissions between groups, when admitted, CAVT patients had shorter mean ICU stays by 0.66 days (LOSR 0.77, 95% CI 0.71-0.84; p< 0.001). Conversely, CAVT had 27% lower odds of PPICU admissions (OR 0.73, 95% CI 0.63-0.85; p< 0.001) and shortened mean PPICU duration by 0.79 days (LOSR 0.71, 95% CI 0.64-0.80; p< 0.001). Overall, accounting for ICU admission probability, CAVT saved 0.35 ICU days per patient (p< 0.0001). Also, CAVT patients had 50% lower odds of step-down unit use (OR 0.50, 95% CI 0.43-0.58; p< 0.001). In-hospital mortality did not differ during index admission, however, within the 30-day follow-up period, CAVT patients were 39% less likely to experience death (OR 0.61, 95% CI 0.38-0.99, p=0.047). CAVT patients had 28% lower odds of 30-day all cause readmissions (OR 0.72, 95% CI 0.60-0.87, p< 0.001), and 41% lower 30-day ALI related readmissions (OR 0.59, 95% CI 0.47-0.74, p< 0.001) compared to OE. After discharge, CAVT patients had over three times the odds of being discharged to home (OR 3.09, 95% CI 2.67-3.58, p< 0.001).

Conclusion: Compared to OE, CAVT is associated with a significant reduction of hospital resources including shorter hospital/ICU stays, lower need for post-procedure-ICU and step-down care, fewer readmissions, and more discharges to home, while potentially improving 30-day survival.