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Outcomes in Critical Limb Ischemia Compared by Distance from Referral Center

Peter B Bartline1, Bjoern D Suckow2, Benjamin S Brooke1

  • 1Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT.

Annals of Vascular Surgery
|August 18, 2016
PubMed

Insights

Patients traveling longer distances for critical limb ischemia (CLI) revascularization had better amputation-free survival (AFS). Referral distance did not negatively impact outcomes or long-term follow-up for CLI patients.

Area of Science:

  • Vascular Surgery
  • Health Services Research

Background:

  • Limited data exist on how referral distance affects outcomes for critical limb ischemia (CLI) patients undergoing revascularization.
  • This study investigated the assumption that longer travel distances correlate with worse outcomes.

Purpose of the Study:

  • To evaluate the impact of referral distance on revascularization outcomes in patients with CLI.
  • To determine if patients traveling over 100 miles experience different results compared to those closer to the treatment center.

Main Methods:

  • Retrospective cohort analysis of 300 CLI patients undergoing revascularization from 2000-2010.
  • Patients were grouped by referral distance (>100 miles vs. <100 miles).
  • Outcomes analyzed included length of stay, functional status, disposition, follow-up, and amputation-free survival (AFS) using Cox models.

Main Results:

  • Patients traveling >100 miles had superior 5-year AFS (73% vs. 56%, P=0.02).
  • Referral distance did not significantly affect length of stay, functional status, or discharge disposition.
  • Long-term follow-up was similar between groups; longer distance was independently associated with improved AFS.

Conclusions:

  • Referral distance does not adversely affect amputation-free survival or long-term follow-up in CLI patients.
  • Patients from rural settings seeking revascularization at tertiary centers can expect comparable outcomes to those living nearer.
Abstract

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