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Published on: September 22, 2020
Emerging trends in nationwide mortality, limb loss, and resource utilization for critical limb ischemia in young
Fidelis Uwumiro1, Victory Okpujie1, Chikodili Nebuwa2
1Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Nigeria.
Insights
Hospitalizations for critical limb ischemia (CLI) and peripheral arterial disease (PAD) increased in young adults from 2016-2020. Outcomes worsened, highlighting an urgent need for PAD risk factor surveillance in this demographic.
Area of Science:
- Vascular Surgery
- Public Health
- Epidemiology
Background:
- Critical limb ischemia (CLI) incidence is rising among young adults.
- Peripheral arterial disease (PAD) affects a growing number of younger individuals.
- Understanding trends in CLI and PAD among young adults is crucial for public health initiatives.
Purpose of the Study:
- To examine trends in CLI hospitalizations among young adults with PAD in the United States.
- To analyze changes in CLI outcomes, including mortality, amputation, and revascularization rates.
- To assess trends in length of hospital stay and total healthcare costs for CLI in this population.
Main Methods:
- Analysis of adult hospitalizations (18-40 years) for PAD/CLI from the 2016-2020 Nationwide Inpatient Sample database.
- Utilized ICD-10 codes to identify relevant patient admissions.
- Employed Jonckheere-Terpstra tests for trend analysis and adjusted costs for inflation.
Main Results:
- CLI hospitalizations increased from 3,265 in 2016 to 4,474 in 2020.
- In-hospital mortality rose from 2.8% to 3.9%, and major amputations increased from 33.2% to 44.6%.
- Mean length of stay and total healthcare costs for CLI also significantly increased during the study period.
Conclusions:
- Hospitalization rates and outcomes for CLI have worsened among young adults.
- There is an urgent need to improve surveillance for PAD risk factors in younger populations.
- Findings underscore the growing burden of PAD and CLI in young adults, necessitating targeted interventions.
Background/Objectives:
Recent trends indicate a rise in the incidence of critical limb ischemia (CLI) among younger adults. This study examines trends in CLI hospitalization and outcomes among young adults with peripheral arterial disease (PAD) in the United States.
Methods:
Adult hospitalizations (18-40 years) for PAD/CLI were analyzed from the 2016-2020 nationwide inpatient sample database using ICD-10 codes. Rates were reported per 1000 PAD or 100,000 cardiovascular disease admissions. Outcomes included trends in mortality, major amputations, revascularization, length of hospital stay (LOS), and hospital costs (THC). We used the Jonckheere-Terpstra tests for trend analysis and adjusted costs to the 2020 dollar using the consumer price index.
Results:
Approximately 63,045 PAD and 20,455 CLI admissions were analyzed. The mean age of the CLI cohort was 32.7 ± 3 years. The majority (12,907; 63.1 %) were female and white (11,843; 57.9 %). Annual CLI rates showed an uptrend with 3265 hospitalizations (227 per 1000 PAD hospitalizations, 22.7 %) in 2016 to 4474 (252 per 1000 PAD hospitalizations, 25.2 %) in 2020 (Ptrend<0.001), along with an increase in PAD admissions from 14,405 (188 per 100,000, 0.19 %) in 2016 to 17,745 (232 per 100,000, 0.23 %%) in 2020 (Ptrend<0.0001). Annual in-hospital mortality increased from 570 (2.8 %) in 2016 to 803 (3.9 %) in 2020 (Ptrend = 0.001) while amputations increased from 1084 (33.2 %) in 2016 to 1995 (44.6 %) in 2020 (Ptrend<0.001). Mean LOS increased from 5.1 (SD 2.7) days in 2016 to 6.5 (SD 0.9) days in 2020 (Ptrend = 0.002). The mean THC for CLI increased from $50,873 to $69,262 in 2020 (Ptrend<0.001). The endovascular revascularization rates decreased from 11.5 % (525 cases) in 2016 to 10.7 % (635 cases) in 2020 (Ptrend = 0.025). Surgical revascularization rates also increased from 4.9 % (225 cases) in 2016 to 10.4 % (600 cases) in 2020 (Ptrend = 0.041).
Conclusion:
Hospitalization and outcomes for CLI worsened among young adults during the study period. There is an urgent need to enhance surveillance for risk factors of PAD in this age group.
