REAL-WORLD CLINICAL OUTCOMES AND HOSPITAL COSTS FOLLOWING LOWER-EXTREMITY BYPASS WITH AUTOLOGOUS VEIN VERSUS SYNTHETIC GRAFTS IN MEDICARE BENEFICIARIES WITH PERIPHERAL ARTERY DISEASE
Author(s)
Ryan J. Imhoff, MS1, Caitlin W. Hicks, MD, MS2, Yvonne Robles, MPH3, Bismark Baidoo, PhD1, Bilal Abdallah, PharmD4.
1Health Economics & Outcomes Research, W.L. Gore & Associates, Elkton, MD, USA, 2Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, USA, 3Panalgo, Boston, MD, USA, 4WL GORE & Associates, Totowa, NJ, USA.
1Health Economics & Outcomes Research, W.L. Gore & Associates, Elkton, MD, USA, 2Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, USA, 3Panalgo, Boston, MD, USA, 4WL GORE & Associates, Totowa, NJ, USA.
OBJECTIVES: Compare real-world clinical outcomes and hospital costs after lower-extremity bypass with autologous vein grafts (AVG) versus synthetic grafts (SG) in Medicare beneficiaries with peripheral artery disease (PAD).
METHODS: This retrospective cohort study used CMS Medicare LDS-SAF data (2016-2024). Patients undergoing lower-extremity bypass for PAD were classified by graft type. Outcomes assessed during index admission, within 90 days after discharge, and through 4 years after index bypass included length of stay (LOS), readmission, infection, ipsilateral major adverse limb events (MALE; open surgical revascularization [OSR], endovascular revascularization [EVR], or major/minor amputation), and inpatient/outpatient hospital costs. Analyses included overall and below-the-knee (BTK) cohorts.
RESULTS: We identified 51,977 patients: 24,407 (47%) AVG, including 23,985 BTK, and 27,570 (53%) SG, including 20,466 BTK. Mean age was 71. AVG recipients had more chronic limb-threatening ischemia, BTK bypass, diabetes, and chronic kidney disease; SG had more smoking and coronary/pulmonary disease.Overall, SG had shorter index LOS (7.0±10.7 vs 8.3±11.5 days) and lower index costs ($28,278±21,371 vs $33,359±24,100; both p<0.0001). At 90 days, SG had lower readmission (32.0% vs 36.5%), infection (9.8 vs 12.2%), amputation (4.8% vs 8.7%), and EVR (1.6 vs 2.7%), but higher OSR (2.5% vs 1.5%; all p<0.0001). Through 4 years, SG had lower MALE (27.5% vs 32.2%) and follow-up costs ($64,355±81,968 vs $70,963±87,275; both p<0.0001).Among BTK bypasses, SG had lower 90-day readmission (34.0% vs 36.6%), amputation (6.1% vs 8.7%), index costs ($29,041±21,869 vs $33,331±23,958) and 90-day costs ($11,259±29,856 vs $13,150±28,404; all p<0.0001). Four-year MALE (32.0% vs 32.3%; p=0.799) and follow-up costs ($70,172 vs $71,064; p=0.48) were similar, with lower EVR (13.7% vs 16.1%) and higher OSR (14.3% vs 6.9%; all p<0.0001) for SG.
CONCLUSIONS: AVG and SG recipients had overlapping but clinically different patient/anatomic characteristics. SGs showed lower observed resource use, costs, complications, amputation, and EVR, but higher OSR; attenuated BTK results support risk-adjusted evaluation.
METHODS: This retrospective cohort study used CMS Medicare LDS-SAF data (2016-2024). Patients undergoing lower-extremity bypass for PAD were classified by graft type. Outcomes assessed during index admission, within 90 days after discharge, and through 4 years after index bypass included length of stay (LOS), readmission, infection, ipsilateral major adverse limb events (MALE; open surgical revascularization [OSR], endovascular revascularization [EVR], or major/minor amputation), and inpatient/outpatient hospital costs. Analyses included overall and below-the-knee (BTK) cohorts.
RESULTS: We identified 51,977 patients: 24,407 (47%) AVG, including 23,985 BTK, and 27,570 (53%) SG, including 20,466 BTK. Mean age was 71. AVG recipients had more chronic limb-threatening ischemia, BTK bypass, diabetes, and chronic kidney disease; SG had more smoking and coronary/pulmonary disease.Overall, SG had shorter index LOS (7.0±10.7 vs 8.3±11.5 days) and lower index costs ($28,278±21,371 vs $33,359±24,100; both p<0.0001). At 90 days, SG had lower readmission (32.0% vs 36.5%), infection (9.8 vs 12.2%), amputation (4.8% vs 8.7%), and EVR (1.6 vs 2.7%), but higher OSR (2.5% vs 1.5%; all p<0.0001). Through 4 years, SG had lower MALE (27.5% vs 32.2%) and follow-up costs ($64,355±81,968 vs $70,963±87,275; both p<0.0001).Among BTK bypasses, SG had lower 90-day readmission (34.0% vs 36.6%), amputation (6.1% vs 8.7%), index costs ($29,041±21,869 vs $33,331±23,958) and 90-day costs ($11,259±29,856 vs $13,150±28,404; all p<0.0001). Four-year MALE (32.0% vs 32.3%; p=0.799) and follow-up costs ($70,172 vs $71,064; p=0.48) were similar, with lower EVR (13.7% vs 16.1%) and higher OSR (14.3% vs 6.9%; all p<0.0001) for SG.
CONCLUSIONS: AVG and SG recipients had overlapping but clinically different patient/anatomic characteristics. SGs showed lower observed resource use, costs, complications, amputation, and EVR, but higher OSR; attenuated BTK results support risk-adjusted evaluation.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO49
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Medical Technologies
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Surgery