Therapy Outcomes and Healthcare Resource Utilization in Computer Assisted Vacuum Thrombectomy Versus Open...

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

A retrospective analysis of discharged adult LE-ALI inpatients (07/01/2020 - 09/30/2023) with a 1:1 propensity score matching using the Vizient Clinical Data Base was performed. Outcomes included length of stay (LOS), post-procedure LOS (PPLOS), post-procedure intensive care unit stay (PPICU), post-procedure composite complications, individual organ system adverse events, 30-day all-cause and ALI-related readmissions, major limb amputation, in-hospital mortality, and discharge destination.

A total of 873 patients per group were matched. Baseline characteristics were similar. CAVT was associated with shorter LOS [5.3±4.4d vs. 7.2±5.76d (EA) and 9.8±6.04d (EAB), P<0.0001] and PPLOS [4.1±4.09d vs 6.1±5.58d (EA) and 7.3±5.41d (EAB), P<0.0001]. PPICU stay was similar across groups. CAVT had fewer composite complications [5.7% vs. 8.2% (EA), P=0.0389 and 12% (EAB), P<0.001]. CAVT had lower 30 days all-cause [14.8% vs. 18.6% (EA), P=0.0358 and 26.6% (EAB), P<0.001] and ALI-related readmissions [6.9% vs. 10.3% (EA), P=0.0130 and 15.3% (EAB), P<0.0001]. Major amputation at 30-days was lower in CAVT [0.93% vs. 2.12% (EA), P=0.0455 and 2.23% (EAB), P=0.0316]. Discharge to home was more common in CAVT [64.6% vs 44.4% (EA) and 36.9% (EAB), P<0.0001]. In hospital mortality was comparable.

Compared to EA and EAB, CAVT is associated with shorter LOS, fewer complications, reduced readmissions and major amputations, and higher rates of discharge to home, without increased mortality.