Timely access to care is directly impacted by insurance coverage and affects outcomes after vascular procedures. We evaluated trends of in-hospital mortality (IHM) for index vascular procedures so as to assess the effects of 2006 Massachusetts (MA) Healthcare Reform (MHR) on the mortality trends. National Inpatient Sample (2003-2011) was queried to identify surgical patients with peripheral arterial disease, carotid stenosis, and abdominal aorta aneurysm based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedure codes. The cohort was then divided into MA and non-MA (NMA) based on the location of the hospital. Two time intervals, 2003-2006 (P1) and after 2006 (P2) were selected for comparisons. The patients at MA and NMA hospitals were described in terms of demographic characteristics and presentation by time interval (P1 vs P2) and compared using χ2 and t-test. Weighted logistic regression with a term modeling change in the odds ratio for second time interval was used to test and estimate trends in mortality and to compare MA and NMA trends. We identified 306,438 patients operated on for peripheral arterial disease, carotid stenosis, and abdominal aortic aneurysm. MA and NMA cohorts were similar, with a significant increase in Elixhauser comorbidity index in P2 (vs P1) in both cohorts (P < .001). Mortality trends are depicted in Fig 1. There was a significant decline in IHM for all vascular patients during both time intervals, although no significant difference in the rate of decline was noted (Table). There was no significant difference in IHM trends in P1 between MA and NMA; however, a significantly higher decrease in IHM was noted in MA compared with NMA in P2 (the annual odds ratio of IHM differed by 18%; P = .010). Overall, a significant decrease in IHM for all vascular procedures was noted in the United States. The decline in postoperative IHM was significantly more rapid in the MA sample after 2006 compared with the NMA sample. This study suggests that better access to care in Massachusetts may be a cause of this decline in IHM.TableAnnual change in in-hospital mortality after vascular operationsContrastOR95% CIP valueOverall annual change0.930.90-0.97<.001 2003-2006 (P1)0.950.93-0.97<.001 2007-2011 (P2)1.020.96-1.08.569P2 vs P1 MA annual change1.050.85-1.29.648P10.780.67-0.91.001P20.740.56-0.99.043P2 vs P1 Non-MA annual change0.930.90-0.97<.001 P10.950.93-0.98<.001 P21.030.97-1.09.405P2 vs P1 MA vs Non-MA (P1)1.130.92-1.39.26 MA vs Non-MA (P2)0.820.70-0.95.01CI, Confidence interval; MA, Massachusetts; OR, odds ratio. Open table in a new tab