Original Investigation
Nationwide Trends of Hospital Admission and Outcomes Among Critical Limb Ischemia Patients: From 2003–2011

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Abstract

Background

Critical limb ischemia (CLI) continues to be a major cause of vascular-related morbidity and mortality in the United States.

Objectives

The study sought to characterize the trends in hospitalization of U.S. patients with CLI from 2003 to 2011, using the Nationwide Inpatient Sample. We compared the cost utilization and in-hospital outcomes of endovascular and surgical revascularization procedures for CLI.

Methods

CLI and revascularization procedures were identified using International Classification of Diseases-Ninth Edition-Clinical Modification codes. In-hospital mortality and amputation were coprimary outcomes. Length of stay (LOS) and cost of hospitalization were secondary outcomes.

Results

We included a total of 642,433 admissions with CLI across 2003 to 2011. The annual rate of CLI admissions has been relatively constant across 2003 to 2011 (∼150 per 100,000 people in the United States). There has been a significant reduction in the proportion of patients undergoing surgical revascularization from 13.9% in 2003 to 8.8% in 2011, while endovascular revascularization has increased from 5.1% to 11.0% during the same time period. This was accompanied by a steady reduction in the incidence of in-hospital mortality and major amputation. Compared to surgical revascularization, endovascular revascularization was associated with reduced in-hospital mortality (2.34% vs. 2.73%, p < 0.001), mean LOS (8.7 days vs. 10.7 days, p < 0.001), and mean cost of hospitalization ($31,679 vs. $32,485, p < 0.001) despite similar rates of major amputation (6.5% vs. 5.7%, p = 0.75).

Conclusions

While CLI admission rates have remained constant from 2003 to 2011, rates of surgical revascularization have significantly declined and endovascular revascularization procedures have increased. This has been associated with decreasing rates of in-hospital death and major amputation rates in the United States. Despite multiple adjustments, endovascular revascularization was associated with reduced in-hospital mortality compared to surgical revascularization during 2003 to 2011.

Key Words

critical limb ischemia
endovascular interventions
peripheral artery disease

Abbreviations and Acronyms

CI
confidence interval
CLI
critical limb ischemia
HCUP
Healthcare Cost and Utilization Project
ICD-9-CM
International Classification of Diseases-Ninth Edition-Clinical Modification
LOS
length of stay
NIS
Nationwide Inpatient Sample
OR
odds ratio
PAD
peripheral artery disease
SES
socioeconomic status

Cited by (0)

All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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