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Delays to revascularization for patients with chronic limb-threatening ischaemia

Qiuju Li1,2, Panagiota Birmpili2,3, Amundeep S Johal2

  • 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.

The British Journal of Surgery
|May 11, 2022
PubMed

Insights

Timely revascularization for chronic limb-threatening ischaemia (CLTI) is crucial. Presentation at arterial hubs, rather than spoke hospitals, significantly reduces delays and improves outcomes for CLTI patients.

Area of Science:

  • Vascular surgery
  • Health services research
  • Ischaemia management

Background:

  • England's vascular services utilize regional hub-and-spoke models for care delivery.
  • Hubs are designated centers for performing complex arterial surgical procedures.
  • This study investigates revascularization timeliness for chronic limb-threatening ischaemia (CLTI).

Purpose of the Study:

  • To analyze the time to revascularization for CLTI patients across various care pathways.
  • To determine the association between revascularization time and post-procedural outcomes.
  • To evaluate the impact of presentation location (hub vs. spoke) on treatment delays.

Main Methods:

  • Retrospective analysis of 16,483 CLTI patients using Hospital Episode Statistics (April 2015-March 2019).
  • Identification and comparison of three inpatient and four outpatient care pathways.
  • Statistical analysis using Cox regression for time-to-event and logistic regression for outcomes.

Main Results:

  • Patients presenting to arterial hubs experienced shorter revascularization times compared to spoke hospitals, both for inpatient (5 vs. 12 days) and outpatient (13 vs. 26 days) pathways.
  • Over 42% of patients were initially seen in outpatient settings.
  • Longer delays were linked to increased risks of major amputation and in-hospital death, though this varied by pathway.

Conclusions:

  • Presentation at an arterial hub significantly influences revascularization time for CLTI patients.
  • Generally, delayed revascularization correlates with poorer postoperative outcomes.
  • The impact of delays on outcomes is pathway-dependent, highlighting the need for tailored strategies.
Abstract

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