Impact of Medicaid Expansion (ME) of the Affordable Care Act on theOutcomes of Lower Extremity Bypass for Patients with Peripheral Artery Disease in the Vascular Quality Initiative (VQI) Database
Mohammad H. Eslami*1, Hanaa Darkour Aridi*2, Efthymios D. Avgerinos*1, Michel S. Makaroun1, Mahmoud Malas*2
1University of Pittsburgh Medical School, Pittsburgh, PA;2University of California, San Diego, CA
Objectives:We aim to evaluate changes in the utilization of care and outcomes of lower extremity bypass (LEB) after Medicaid Expansion (ME). Methods:We used interrupted time-series analysis (ITS) to compare utilization and outcomes, between ME-adopter states ME [MES] vs. non-adopters [NMES] using VQI LEB database (2010-2017). Primary outcomes included post-operative mortality (POD) and major adverse limb events (MALE) at 1-year of follow-up. Results:Of 26,446 cases, 13,955 (52.8%) were performed in MES and 12491 (47.2%) in NMES. The indications for bypass were tissue loss (38.8%), claudication (25.3%), rest pain (22.8%), and acute ischemia (13.2%). There was an annual decrease in LEB for acute ischemia [annual change in post vs. pre-ME period (95%CI): -4.3% (-7.5%,-1.0%), p=0.02] and an increase for claudication [3.7% (1.7%, 5.6%), p=0.01]. Elective procedures increased in MES [3.9% (0.1%, 7.7%), p=0.05] along with a significant annual decrease in POD in the post-ME vs. pre-ME period. There was also a significant decrease in MALE [-9.0% (-20.3%, 2.3%, P=0.09). Compared to the annual trend changes in NMES, MES showed a significant increase in the utilization of LEB for claudicants and elective cases, and a decrease in POD and MALE at 1-year of follow-up (Figure). Conclusions:The adoption of ME was associated with significant increase in the use of LEB for non-severe and elective cases, along with improved POD and MALE at 1-year.
* By Invitation
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