Therapy Outcomes and Healthcare Resource Utilization in Computer-Assisted Vacuum Thrombectomy versus Open Embolectomy: The THRIVE Study.

PURPOSE: To evaluate resource use and clinical outcomes in patients with lower extremity (LE) acute limb ischemia (ALI) managed with computer-assisted vacuum thrombectomy (CAVT), embolectomy alone (EA), or embolectomy with adjunctive bypass (EAB) in the United States.

MATERIALS AND

METHODS

A retrospective analysis of discharged adult LE-ALI inpatients (July 1, 2020, to September 30, 2023) with a 1:1 propensity score matching using the Vizient Clinical Data Base was performed. Outcomes included length of stay (LOS), postprocedural LOS, postprocedural intensive care unit stay, postprocedural composite complications, individual organ system adverse events, 30-day all-cause- and ALI-related readmissions, major limb amputation, in-hospital mortality, and discharge destination.

RESULTS

A total of 873 patients per group were matched. Baseline characteristics were similar. CAVT was associated with shorter LOS (5.3 days [SD ± 4.4] vs 7.2 days [SD ± 5.76] for EA and 9.8 days [SD ± 6.04] for EAB; P < .0001) and postprocedural LOS (4.1 days [SD ± 4.09] vs 6.1 days [SD ± 5.58] for EA and 7.3 days [SD ± 5.41] for EAB; P < .0001]. Postprocedural intensive care unit stay was similar across groups. CAVT had fewer composite complications (5.7% vs 8.2% [EA]; P = .0389, and 12% [EAB]; P < .001]. CAVT had lower 30 days all-cause- (14.8% vs 18.6% [EA]; P = .0358, and 26.6% [EAB]; P < .001] and ALI-related readmissions (6.9% vs 10.3% [EA]; P = .0130, and 15.3% [EAB]; P < .0001]. Major amputation at 30 days was lower in CAVT (0.93% vs 2.12% [EA]; P = .0455, and 2.23% [EAB]; P = .0316). Discharge to home was more common in CAVT (64.6% vs 44.4% [EA] and 36.9% [EAB]; P < .0001). In hospital mortality was comparable.

CONCLUSIONS

Compared with EA and EAB, CAVT is associated with shorter LOS, fewer complications, reduced readmissions and major amputations, and higher rates of discharge to home, without increased mortality.