Abstract 16190: Trends in Admissions and Outcomes in Patients With Chronic Limb-threatening Ischemia-a National Inpatient Sample Analysis

Abstract

Introduction: Chronic limb threatening ischemia (CLTI) morbidity and mortality rates have historically been higher, however recent trends have not been reported. In patients admitted with CLTI, we aimed to examine trends in in-hospital mortality, major amputations, length of stay, and cost of admissions overall, and stratified by type of revascularization procedures. Hypothesis: We hypothesized there would be an increase in CLTI-related admissions, with outcomes only marginally improving. Methods: Using 2011-2017 National Inpatient Sample data, we identified CLTI-related admissions based on ICD-9 and 10-CM codes. We stratified outcomes based on endovascular or open surgical interventions. We also performed multivariable regression analyses based on age, sex, race, hospital size, type and location. Results: We identified 2,643,087 CLI-related admissions between 2011 and 2017. CLI admissions increased from 0.9% to 1.4% P trend <0.0001 as well as overall PAD admissions (4.5% to 8.9%, P trend <0.0001). In-hospital mortality for the entire CLTI cohort decreased from 3.3% to 2.7%, P trend <0.0001 and major amputations decreased from 10.9% to 7%, P trend <0.0001. A decline was also noted for length of stay from 5.7 (3.1-10.1) to 5.4 (3.0-9.2) (P trend <0.0001), whereas admission costs increased from 11,791 (6,676 - 21,712) to 12,597 (7,248 - 22,748) (P trend <0.0001). The volume of endovascular interventions increased (P<0.0001) against a decline in surgical interventions (P<0.0001). Black race, female sex and age ≥60 years were associated with higher in-hospital mortality. Conclusions: A relatively small decrease in absolute numbers for mortality and major amputations were observed against a backdrop of increasing CLTI admission volumes over recent years. As patients with CLTI receive more endovascular interventions than surgical interventions over time, mortality rates and length of stay have generally improved.