Abstract 16822: Short Term Outcomes of Endovascular and Surgical Therapies for Critical Limb Ischemia: A Nationwide Analysis

Abstract

Background: Endovascular therapy (EVT) and peripheral arterial bypass surgery (PABS) are established revascularization modalities in patients with critical limb ischemia (CLI). However, there is limited data regarding the short term outcomes of both procedures. Research question: Is there a difference between the in-hospital outcomes of EVT and PABS for patients with CLI? Methods: Patients with a diagnosis of CLI in the National Inpatient Sample database were reviewed from 2018 to 2020, and stratified into EVT and PABS groups. The primary outcome was in-hospital mortality and secondary outcomes included in-hospital complications. Multivariate logistic regression was used to adjust for confounders. Results: A total of 14,015 adult patients with CLI were identified (EVT:11,970; PABS: 2045). There was no significant difference in the in-hospital mortality between the two groups (adjusted odds ratio [aOR] 0.43, 95%CI 0.10-1.89 p=0.264). Furthermore, there was no significant difference in the rates of in-hospital complications: septic shock (aOR 0.67, 95%CI 0.18-2.36, p=0.529), acute stroke (aOR 0.54, 95%CI 0.12-2.36, p=0.413), cardiogenic shock (aOR 0.89, 95%CI 0.14-7.84, p=0.973), vascular complications, (aOR 1.66, 95%CI 0.67-4.11, p=0.278), compartment syndrome (aOR 0.24, 95%CI 0.03-1.90, p=0.177), and acute kidney injury (aOR 1.30, 95%CI 0.88-1.90, p=0.184) between the two groups fig 1 . In addition, the mean length of stay was comparable between the groups 5.95 vs 6.14 days (adjusted mean difference[aMD] 0.23, 95%CI -0.31-0.78, p=0.298. However, the mean hospital costs were significantly lower for the PABS group compared to the EVT group ($24,463 vs $29,400, aMD 0.87 $-3,684, 95%CI $-5,813-$-1,554, p=0.001). Conclusion: Endovascular therapy and bypass surgery for CLI had comparable in-hospital mortality and in-hospital complications, although, the hospital cost was significantly higher with endovascular therapy.