Charges, Reimbursement, and Healthcare Resource Utilization in Patients with Extremity Arterial Injury in the United States: Analysis of Linked Hospital Chargemaster and Claims Data

Background/Objectives: Successful revascularization following extremity arterial injury is critical for survival and limb salvage. Graft repair is required in ~45% of patients, with the autologous vein preferred for its efficacy and safety. When unavailable, synthetic or non-autologous grafts are associated with infection, amputation, and reduced durability. Extremity arterial injury-specific cost data are lacking, with estimates extrapolated from the general trauma literature. This study characterized the costs and post-discharge healthcare resource utilization (HCRU) for U.S. adults with extremity arterial injury undergoing graft repair. Methods: Adults with extremity arterial injury undergoing graft repair (January 2018 to March 2023) were identified from the linked PINC AI Healthcare Database and Inovalon all-payer claims. Hospitalization charges, costs, and 18-month post-discharge HCRU and costs were assessed. Two-part models estimated cost drivers, adjusted for demographics, clinical characteristics, and complications. Results: Among 964 patients, grafts were autologous (74%), synthetic (14%), other (6%), or multiple (6%). Mean initial hospitalization charges and reimbursed costs were $316,600 and $75,947, respectively. Charges/costs increased with orthopedic fracture (+$639,558/+$91,462), graft infection (+$589,921/+$84,598), and amputation (+$492,986/+$116,611) (all p < 0.05). Mean post-discharge costs were $70,222 at 6 months and $93,639 at 18 months. Initial hospitalization complications predicted increased post-discharge costs: orthopedic fracture ($138,683–$145,360) and graft infection ($389,376–$422,224) (both p < 0.01). Post-discharge aneurysm, graft infection, and thrombectomy were also associated with higher costs (all p < 0.05). Post-discharge HCRU was lowest and most stable with the autologous vein. Conclusions: In-hospital and post-discharge complications are major cost drivers following arterial graft repair. Graft infection was associated with significantly increased costs across both periods, and non-autologous graft use was associated with disproportionately higher 18-month HCRU.