Therapy Outcomes and Healthcare Resource Utilization in Computer Assisted Vacuum Thrombectomy Versus Open Embolectomy: The THRIVE Study.

PURPOSE: To evaluate resource use and clinical outcomes in patients with lower extremity acute limb ischemia (LE-ALI) managed with computer-assisted vacuum thrombectomy (CAVT), embolectomy alone (EA), or embolectomy with adjunctive bypass (EAB) in the United States. METHODS: A retrospective analysis of discharged adult LE-ALI inpatients (07/01/2020 - 09/30/2023) with a 1:1 propensity score matching using the Vizient Clinical Data Base was performed. Outcomes included length of stay (LOS), post-procedure LOS (PPLOS), post-procedure intensive care unit stay (PPICU), post-procedure composite complications, individual organ system adverse events, 30-day all-cause and ALI-related readmissions, major limb amputation, in-hospital mortality, and discharge destination. RESULTS: A total of 873 patients per group were matched. Baseline characteristics were similar. CAVT was associated with shorter LOS [5.3±4.4d vs. 7.2±5.76d (EA) and 9.8±6.04d (EAB), P<0.0001] and PPLOS [4.1±4.09d vs 6.1±5.58d (EA) and 7.3±5.41d (EAB), P<0.0001]. PPICU stay was similar across groups. CAVT had fewer composite complications [5.7% vs. 8.2% (EA), P=0.0389 and 12% (EAB), P<0.001]. CAVT had lower 30 days all-cause [14.8% vs. 18.6% (EA), P=0.0358 and 26.6% (EAB), P<0.001] and ALI-related readmissions [6.9% vs. 10.3% (EA), P=0.0130 and 15.3% (EAB), P<0.0001]. Major amputation at 30-days was lower in CAVT [0.93% vs. 2.12% (EA), P=0.0455 and 2.23% (EAB), P=0.0316]. Discharge to home was more common in CAVT [64.6% vs 44.4% (EA) and 36.9% (EAB), P<0.0001]. In hospital mortality was comparable. CONCLUSION: Compared to EA and EAB, CAVT is associated with shorter LOS, fewer complications, reduced readmissions and major amputations, and higher rates of discharge to home, without increased mortality.