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Critical limb ischaemia in the time of COVID-19: establishing ambulatory service provision

M Chana1, S Muse1, S Ball2

  • 1The Royal Devon and Exeter Hospital, UK.

Annals of the Royal College of Surgeons of England
|December 23, 2021
PubMed

Insights

The COVID-19 pandemic shifted critical limb ischaemia (CLI) care to ambulatory pathways, significantly reducing hospital stays. This study demonstrates safe and effective CLI management outside traditional hospital settings, aligning with best practices.

Area of Science:

  • Vascular Surgery
  • Healthcare Management
  • Public Health

Background:

  • The COVID-19 pandemic necessitated rapid changes in healthcare delivery, impacting vascular surgery services.
  • A dedicated urgent 'hot clinic' was established for ambulatory care of critical limb ischaemia (CLI) patients.
  • The study evaluates CLI service provision at Royal Devon and Exeter before and during the pandemic against best practices.

Purpose of the Study:

  • To describe the critical limb ischaemia (CLI) service before and during the COVID-19 pandemic.
  • To evaluate the CLI service against established best practice guidelines.
  • To assess the impact of pandemic-induced changes on patient outcomes and care pathways.

Main Methods:

  • Retrospective review of patient records for CLI patients during pre-COVID and COVID-19 periods.
  • Comparison of primary outcome measures against guidelines from the Vascular Society of Great Britain and Ireland.
  • Analysis included patient numbers, length of stay, referral to review times, multidisciplinary team meeting (MDT) participation, intervention times, management strategies, and survival rates.

Main Results:

  • Patient numbers for CLI were 29 (non-COVID) vs 21 (COVID-19).
  • Median length of stay decreased from 15 to 0 days (p<0.001), with no significant change in time to specialist review (0 vs 3 days).
  • Conservative management increased (52% vs 67%), while endovascular interventions decreased (28% vs 10%); 30-day survival remained similar (79% vs 76%).

Conclusions:

  • The COVID-19 pandemic accelerated the adoption of ambulatory care pathways for CLI diagnosis and intervention.
  • A significant reduction in length of stay was observed without compromising key clinical outcomes or timely specialist review.
  • The study confirms that CLI patients can be safely and effectively managed via ambulatory care, adhering to best practices.
Abstract

Keywords:
Ambulatory careCOVIDCritical limb ischaemia –Limb salvageOutcomes

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