OBJECTIVES: This study uses data from hospitals across the United States to estimate the economic burden when treating patients with advanced Peripheral Arterial Disease (PAD) with either revascularization or amputation.

METHODS: Data was derived from the MedAssets health system database of more than 400 hospitals across 42 states for the years 2010-2014. To be eligible for inclusion, inpatient hospitalizations required a primary diagnosis of PAD, a record of an intervention (revascularization or major/minor amputation exclusively) and expected payment information. Multivariable models were fitted for adverse events, length of stay (LOS), and expected payment per day; comparing the different interventions with adjustments for baseline patient characteristics, comorbid conditions and hospital characteristics.

RESULTS: Of the over 17 million inpatient hospitalizations in the database, 62,883 (0.4%) have a primary diagnosis of PAD, with 48,072 (76.4%) having a record of the following intervention: revascularization alone 35,220 (73.3%), major amputation alone 6,852 (14.3%), minor amputation alone 2,103 (4.4%), and 3,897 (8.1%) having more than one procedure (excluded from multivariable analysis). Multivariable models of adverse events show patients with major amputation are at higher risk of pulmonary complications (OR 1.50 [1.25, 1.80]; P≤0.0001) and sepsis/infections (OR 2.65 [2.06, 3.41]; P≤0.0001) when compared to patients with revascularization. Multivariable models also show patients with major (10.0 vs 6.7 days; P≤0.0001) and minor amputation (8.2 vs 6.7 days; P≤0.0001) have longer stays. This finding contributes to less expected payment per day for patients with major amputation ($2,878 vs $4,592; P≤0.0001) and minor amputation ($2,797 vs $4,592; P≤0.0001) as well.

CONCLUSIONS: PAD affects a significant number of inpatient admissions with a substantial hospital burden due to the complications and long lengths of stays typically associated with leg amputation. Hospital limb salvage programs that include revascularization procedures/algorithms may reduce this burden while providing cost savings to the hospital.