RS16 - Treatment Outcomes and Healthcare Resource Utilization In Computer-assisted Vacuum Thrombectomy vs Open Embolectomy for Acute Limb Ischemia: The THRIVE Study

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

Methods: This retrospective study utilized the Vizient Clinical Data Base 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 was performed at a 1:1:1 ratio based on patient demographics and comorbidities, payer and hospital type. Outcomes studied included post-procedure composite complication and individual organ system adverse events, all-cause and ALI-related readmission rates, major limb amputation, and in-hospital mortality. Statistical analyses included ANOVA F-tests, Kruskal-Wallis, or Chi-Square tests.

Results: 873 CAVT patients were matched to EA and EAB patients, respectively. Baseline characteristics were similar between groups. The CAVT cohort had differences in racial composition (p < 0.0001) with more white patients (72.2%) than the EA (64.8%) and EAB (63.6%) group, and the EAB group held a higher Elixhauser Comorbidity Index (ECI) score compared to CAVT (5.2 vs 6.5, p=0.0190). Composite complication rates were significantly lower for CAVT (5.7%) as compared to both EA (8.2%, p=0.0389) and EAB (12%, p< 0.0001) treatments. With respect to individual organ system adverse events, CAVT patients incurred a significantly lower incidence of acute kidney injury as compared to EA (4.7% vs 8.1%, p= 0.0034) and EAB (10.4%, p< 0.0001) patients, as well as lower rates of post operative infection against the EA (0% vs 1.3%, p= 0.0009) and EAB (2.2%, p< 0.0001) cohorts. Additionally, patients treated with CAVT experienced fewer in-hospital strokes (0.7% vs 2.2%, p=0.0088) and post-operative shock (0% vs 1.3%, p=0.0009) compared to EAB patients. Hospital readmission within 30-days was lower following treatment with CAVT against comparator groups for both all-cause [(vs EA, 14.8% vs 18.6%, p=0.0358); (vs EAB, 14.8% vs 26.5%, p< 0.0001)], and ALI-related readmissions [(vs EA, 6.8% vs 10%, p=0.0155); (vs EAB, 6.8% vs 14.9%, p< 0.0001)]. Major limb amputation at 30-days was significantly lower for CAVT (0.93%) as compared to EA (2.12%, p=0.0316) and EAB (2.23%, p=0.0455) groups. In-hospital mortality was similar between groups (CAVT 1.9%, EA 2.9%, p=0.2115, EAB 2.5%, p=0.4181).

Conclusions: As compared to open surgery, patients with LE-ALI treated with CAVT experience significantly fewer major limb amputations, lower post-procedure composite and individual organ system complications, and lower all-cause and ALI-related readmissions without increased mortality.