Lower Extremity Artery Endovascular Intervention Outcomes in Patients with Autoimmune Rheumatic Disease: an Analysis of the US Nationwide Inpatient Sample 2012 - 2020.

Abstract

This study aimed to evaluate national level differences in in hospital outcomes among patients with autoimmune rheumatic diseases (AIRDs) undergoing endovascular interventions for lower extremity arterial disease (LEAD). This was a retrospective, observational cohort study using a large nationwide administrative database. Adult patients diagnosed with LEAD who underwent percutaneous endovascular interventions were analysed using the 2012 - 2020 Nationwide Inpatient Sample. Patients were stratified into four groups: systemic lupus erythematosus (SLE); rheumatoid arthritis (RA); systemic sclerosis (SSc); and a reference group without these conditions. Multivariable logistic regression was used to assess associations between AIRDs and in hospital mortality, discharge to a long term care facility (LTCF), prolonged hospital length of stay (LoS), and in hospital complications. Among 71 436 weighted patients, 1 739 (2.4%) had an AIRD (SLE, 0.4%; RA, 1.8%; SSc, 0.2%). Compared with the reference group, patients with RA had a statistically significantly greater risk of discharge to an LTCF (adjusted odds ratio [aOR] 1.41), prolonged LoS (aOR 1.39), and any in hospital complication (aOR 1.33), including sepsis, infections, and below knee amputation. Patients with SSc exhibited higher odds of pneumonia (aOR 2.02), respiratory failure (aOR 1.77), and minor amputations (aOR 2.89). No statistically significant differences were observed in death or total hospital costs among groups. Patients with SLE had outcomes comparable with those of the general population. Although in hospital mortality rates were similar across all groups, patients with RA were at a significantly higher risk of infective complications and major amputation during hospitalisation following endovascular intervention for LEAD. These findings underscore the need for proactive peri-operative planning and multidisciplinary care strategies tailored to the unique risks and needs of this patient population.