OR9-1 | Variations in Revascularization Strategies for Chronic Limb-Threatening Ischemia: A Nationwide Analysis of Medicare Beneficiaries

Recent trial data support both surgical-first and endovascular-first revascularization approaches for chronic limb-threatening ischemia (CLTI), but variations and outcomes associated with each strategy among capable hospitals are lacking. Medicare beneficiaries with CLTI treated at hospitals offering both endovascular and surgical treatments between 10/1/2015 to 12/31/2021 were analyzed. Cumulative incidence of major amputation at 1 year were calculated across quintiles of treatment use. Gray's p-value was generated to account for competing mortality risk. Among 196,070 patients at 1832 institutions, 161,771 (82.5%) underwent endovascular treatment. Patients undergoing endovascular treatment were older, more often female, and more likely to have comorbidities. Median institutional rates were 80.1% and 19.9% for endovascular treatment and surgery, respectively. The adjusted means odd ratio was 2.32 between hospitals (IQR, 2.24-2.40; p<.05) (Figure), demonstrating high variability in intervention use. Patients who underwent endovascular intervention at hospitals with the lowest quintile of endovascular use had a 1-year incidence of major amputation of 8.9% vs. 7.8% in the highest quintile (p<.01). Among patients who underwent surgery, the incidence was 8.2% in the lowest quintile of surgical use vs. 8.7% in the highest (p=.10). This study showed large interhospital variability in treatment use for CLTI, as well as improved outcomes for patients receiving endovascular treatment at higher volume sites. Further work is needed to standardize treatments with the goal of improving limb salvage rates.