Treatment Variability Among Patients Hospitalized for Chronic Limb‐Threatening Ischemia: An Analysis of the 2016 to 2018 US National Inpatient Sample

Abstract

Background Little is known about treatment variability across US hospitals for patients with chronic limb‐threatening ischemia (CLTI). Methods and Results Data were collected from the 2016 to 2018 National Inpatient Sample. All patients aged ≥18 years, admitted to nonfederal US hospitals with a primary diagnosis of CLTI, were identified. Patients were classified according to their clinical presentation (rest pain, skin ulceration, or gangrene) and were further characterized according to the treatment strategy used. The primary outcome of interest was variability in CLTI treatment, as characterized by the median odds ratio. The median odds ratio is defined as the likelihood that 2 similar patients would be treated with a given modality at 1 versus another randomly selected hospital. There were 15 896 (weighted n=79 480) hospitalizations identified where CLTI was the primary diagnosis. Medical therapy alone, endovascular revascularization ± amputation, surgical revascularization ± amputation, and amputation alone were used in 4057 (25%), 5390 (34%), 3733 (24%), and 2716 (17%) patients, respectively. After adjusting for both patient‐ and hospital‐related factors, the median odds ratio (95% CI) for medical therapy alone, endovascular revascularization ± amputation, surgical revascularization ± amputation, any revascularization, and amputation alone were 1.28 (1.19–1.38), 1.86 (1.77–1.95), 1.65 (1.55–1.74), 1.37 (1.28–1.45), and 1.42 (1.27–1.55), respectively. Conclusions Significant variability in CLTI treatment exists across US hospitals and is not fully explained by patient or hospital characteristics.