What Specific Factors Has the Medicaid Expansion Influenced or Affected Regarding the Management and Surgical Outcomes of Patients With Peripheral Arterial Disease?

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Within the field of vascular surgery, limited research has been done on how the Medicaid Expansion impacts the presentation and management of patients with peripheral arterial disease (PAD) in the United States. To our knowledge, there has not been a published systematic review on this topic. Therefore, we aim to review the current literature not only to establish a consensus on the effects of Medicaid Expansion on PAD presentation and management, but identify specific factors affected. This systematic review included searches of databases, registrars, and other sources while following the P2020 Flow recommended by PRISMA. We used five databases: PubMed, Cochrane, CINAHL Plus, Medline, and Web of Science and two registries: PRISMA and Prospero. Keywords used were “Medicaid,” “Medicaid Expansion,” “Affordable Care Act,” “Insurance Status,” “Healthcare Reform Laws,” “Payer Status,” “Peripheral Arterial Disease,” and “Vascular.” Our extensive search produced only six articles (Table). All six studies demonstrated an increase in patient insurance coverage and the utilization of vascular surgery by Medicaid patients following the Medicaid Expansion. However, all other outcomes investigated differed across all six studies depending on the methodization, specifically which type of database was used and inclusion criteria. A decrease in mortality of PAD patients between before and after Medicaid Expansion was seen in studies that used a national database as compared to a state database. An increase in the utilization of amputations and revascularization was seen by studies that did not control for the following specific factors: race, ethnicity, severity, and the presence of acute or chronic limb ischemia. When these factors were controlled for no change or a decrease in the rate of these procedures was seen. This review reveals that the Medicaid Expansion had a positive impact on the field of vascular surgery, but additional investigations are needed to clarify specific factors affected and patient related outcomes. Specifically, the discrepancy found between mortality rates and database utilization should be explored further. As well as, the relationship identified between the procedure rates, specific confounding factors (race, ethnicity, severity of disease, and the presence of acute or chronic limb ischemia), and the Medicaid expansion.TableLiterature review resultsAuthorOriginYearJournalTitleEslami et alUS2018J Vasc SurgImproved access to health care in Massachusetts after 2006 Massachusetts Healthcare Reform Law is associated with a significant decrease in mortality among vascular surgery patientsDuke et alUS2019Ann Vasc SurgEffects of the Affordable Care Act on vascular patient amputation rates in ArkansasEslami et alUS2019Ann SurgImpact of Medicaid expansion of the Affordable Care on the outcomes of lower extremity bypass for patients with peripheral artery disease in the Vascular Quality Initiative DatabaseBennett et alUS2019J Surg ResThe impact of Medicaid expansion on utilization of vascular procedures and rates of amputationEquia et alUS2020Ann Vasc SurgThe impact of the Affordable Care Act Medicaid Expansion on vascular surgeryRamadan et alUS2022Ann Vasc SurgThe differential impact of Medicaid Expansion on disparities in outcomes following peripheral vascular intervention Open table in a new tab