Charges, Reimbursement, and Healthcare Resource Utilization in Patients with Extremity Arterial Injury in the United...

Successful revascularization following extremity arterial injury is critical for survival and limb salvage. Graft repair is required in ~45% of patients, with the autologous vein preferred for its efficacy and safety. When unavailable, synthetic or non-autologous grafts are associated with infection, amputation, and reduced durability. Extremity arterial injury-specific cost data are lacking, with estimates extrapolated from the general trauma literature. This study characterized the costs and post-discharge healthcare resource utilization (HCRU) for U.S. adults with extremity arterial injury undergoing graft repair.

Adults with extremity arterial injury undergoing graft repair (January 2018 to March 2023) were identified from the linked PINC AI Healthcare Database and Inovalon all-payer claims. Hospitalization charges, costs, and 18-month post-discharge HCRU and costs were assessed. Two-part models estimated cost drivers, adjusted for demographics, clinical characteristics, and complications.

Among 964 patients, grafts were autologous (74%), synthetic (14%), other (6%), or multiple (6%). Mean initial hospitalization charges and reimbursed costs were $316,600 and $75,947, respectively. Charges/costs increased with orthopedic fracture (+$639,558/+$91,462), graft infection (+$589,921/+$84,598), and amputation (+$492,986/+$116,611) (all p < 0.05). Mean post-discharge costs were $70,222 at 6 months and $93,639 at 18 months. Initial hospitalization complications predicted increased post-discharge costs: orthopedic fracture ($138,683-$145,360) and graft infection ($389,376-$422,224) (both p < 0.01). Post-discharge aneurysm, graft infection, and thrombectomy were also associated with higher costs (all p < 0.05). Post-discharge HCRU was lowest and most stable with the autologous vein.

In-hospital and post-discharge complications are major cost drivers following arterial graft repair. Graft infection was associated with significantly increased costs across both periods, and non-autologous graft use was associated with disproportionately higher 18-month HCRU.