Costs and Resource Burden of Major Lower Extremity Amputations in CLTI Patients

Introduction: Limb salvage is critical in the care of patients suffering from chronic limb threatening ischemia (CLTI). Nevertheless, a substantial proportion of patients, particularly those considered ‘no-option’, eventually undergo major lower extremity amputation (LEA). Our objective was to assess the costs and resource burden associated with hospital admissions for major LEA in CLTI patients.Methods:The Medicare MedPAR 2022 inpatient hospital dataset was analyzed to identify all episodes of care with ICD-coded diagnosis of Rutherford grade 5/6 peripheral artery disease, concurrent coding of a major LEA procedure, and payment through one of the three major LEA Medicare severity-adjusted diagnosis related groups (MS-DRGs). The analysis population was stratified into cohort 1: consisting of ‘high anatomical complexity’ patients, defined as having a concurrent diagnosis code of chronic total occlusion which included patients who were considered ‘no-option’; and cohort 2: the remaining patients. Resource utilization, costs, and outcomes were reported, including in-hospital mortality, mean total length-of-stay (LOS) and intensive care unit (ICU) days, costs derived from charges, per-episode reimbursement amounts, and discharges to skilled nursing facility/inpatient rehabilitation.Results: The analysis included 4,677 CLTI patients with major LEA, of whom 276 were cohort 1 patients. For cohort 1 and cohort 2, respectively, in-hospital mortality was 5.1% and 3.5%; LOS days were 16.6 and 13.7; ICU days were 2.9 and 2.4; costs were $42,063 and $32,706, while reimbursed amounts were $34,721 and $30,898; and 76.5% and 73.9% patients were discharged to skilled nursing facilities or inpatient rehabilitation care.Discussion: Contemporary data from the Medicare population suggest hospitalizations for major LEA impose significant costs and resource burden in CLTI patients. This burden may be particularly pronounced in ‘no-option’ CLTI patients, presenting economic challenges to payers and providers alike. Calibrating the ICD codes will help to further elucidate these rates in ‘no option’ patients.References: