HOSPITAL LENGTH OF STAY AMONG MEDICARE BENEFICIARIES UNDERGOING TRANSCAROTID ARTERY REVASCULARIZATION VERSUS CAROTID ENDARTERECTOMY: A RETROSPECTIVE CLAIMS ANALYSIS
Author(s)
Sumaira Macdonald, MD, PhD, Alysha M. McGovern, MBA, Kimberly Munro, MS, Wendy Wifler, MBA, Abimbola O. Williams, MPH, MS;
Boston Scientific, Marlborough, MA, USA
Boston Scientific, Marlborough, MA, USA
OBJECTIVES: Variation in length of stay (LOS) across carotid revascularization procedures can influence hospital bed capacity and overall resource utilization. This study compared inpatient LOS for transcarotid artery revascularization (TCAR) versus carotid endarterectomy (CEA) among Medicare beneficiaries.
METHODS: The Medicare 100% Standard Analytical Files were used to conduct a retrospective claims analysis from the payer perspective. Beneficiaries aged ≥65 with extracranial carotid artery disease who underwent TCAR or CEA from 01/01/2021-12/31/2024 were identified. Symptomatic and asymptomatic patients at both high and standard surgical risk for CEA were included. Continuous Medicare Fee-for-Service enrollment for ≥12 months pre-index was required. Patients who underwent intracranial thrombectomy or coronary artery bypass grafting during the index encounter were excluded. LOS was defined as number of inpatient days during the index hospitalization. Mean and median differences were assessed using unpaired t-tests and Mann-Whitney tests, respectively.
RESULTS: The cohort included 15,316 TCAR and 77,733 CEA patients. Mean inpatient LOS was shorter for TCAR patients (2.33 ± 3.36 days) than CEA patients (2.44 ± 3.57 days; p<0.01). The absolute mean LOS difference of 0.11 days (≈2.6 hours) corresponds to approximately 11 hospital bed-days saved per 100 TCAR cases relative to CEA. Median LOS was 1 day for both procedures (interquartile range: 1-2 days); however, LOS distributions differed significantly, with CEA exhibiting more pronounced right-skewness driven by more frequent prolonged stays (p<0.01). Relative to CEA, fewer TCAR patients had stays >1 day (33.7% vs. 35.3%) or >2 days (20.9% vs. 22.4%; both p<0.01).
CONCLUSIONS: Among Medicare beneficiaries aged ≥65, TCAR was associated with statistically significant reductions in LOS and fewer prolonged hospitalizations versus CEA. At scale, these differences may translate to meaningful efficiency gains through reduced inpatient resource utilization and increased bed-day availability. Further analysis of downstream economic implications may help quantify the broader value of TCAR for health systems and payers.
METHODS: The Medicare 100% Standard Analytical Files were used to conduct a retrospective claims analysis from the payer perspective. Beneficiaries aged ≥65 with extracranial carotid artery disease who underwent TCAR or CEA from 01/01/2021-12/31/2024 were identified. Symptomatic and asymptomatic patients at both high and standard surgical risk for CEA were included. Continuous Medicare Fee-for-Service enrollment for ≥12 months pre-index was required. Patients who underwent intracranial thrombectomy or coronary artery bypass grafting during the index encounter were excluded. LOS was defined as number of inpatient days during the index hospitalization. Mean and median differences were assessed using unpaired t-tests and Mann-Whitney tests, respectively.
RESULTS: The cohort included 15,316 TCAR and 77,733 CEA patients. Mean inpatient LOS was shorter for TCAR patients (2.33 ± 3.36 days) than CEA patients (2.44 ± 3.57 days; p<0.01). The absolute mean LOS difference of 0.11 days (≈2.6 hours) corresponds to approximately 11 hospital bed-days saved per 100 TCAR cases relative to CEA. Median LOS was 1 day for both procedures (interquartile range: 1-2 days); however, LOS distributions differed significantly, with CEA exhibiting more pronounced right-skewness driven by more frequent prolonged stays (p<0.01). Relative to CEA, fewer TCAR patients had stays >1 day (33.7% vs. 35.3%) or >2 days (20.9% vs. 22.4%; both p<0.01).
CONCLUSIONS: Among Medicare beneficiaries aged ≥65, TCAR was associated with statistically significant reductions in LOS and fewer prolonged hospitalizations versus CEA. At scale, these differences may translate to meaningful efficiency gains through reduced inpatient resource utilization and increased bed-day availability. Further analysis of downstream economic implications may help quantify the broader value of TCAR for health systems and payers.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO4
Topic
Clinical Outcomes
Topic Subcategory
Performance-based Outcomes
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)