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The risk of harm whilst waiting for varicose veins procedure
Roshan Bootun1,2, Mandy Burrows2, Mohammed M Chowdhury2,3
1Vascular Trainee, East of England Deanery, United Kingdom, and Honorary Research Fellow, Section of Vascular Surgery, Imperial College London, UK.
Insights
Delaying varicose vein (VV) surgery during the COVID-19 pandemic caused significant harm, including major complications and reduced quality of life (QoL) for patients awaiting procedures. These findings emphasize the need for timely interventions for VV patients.
Area of Science:
- Vascular Surgery
- Public Health
- Patient Outcomes
Background:
- Varicose veins (VV) significantly impair quality of life (QoL) and pose risks of severe complications like bleeding, ulceration, and phlebitis.
- During the COVID-19 pandemic, VV interventions were classified as lowest priority by the Vascular Society of Great Britain and Ireland (VSGBI) and GIRFT, leading to prolonged waiting times.
Purpose of the Study:
- To assess the harm and impact on QoL for patients with varicose veins experiencing delays of over one year for their surgical procedures.
- To quantify the incidence of major and minor harm, as well as psychological distress, in patients awaiting VV intervention.
Main Methods:
- A prospective study was conducted at Norfolk and Norwich University Hospital, including patients with VV awaiting intervention for over a year.
- Quality of life questionnaires (EQ-VAS, EQ-5D, AVVQ, CIVIQ-14) and telephone consultations were used to assess harm and QoL.
- Patients with CEAP C6 disease were excluded due to high risk during the pandemic; no control groups were used.
Main Results:
- Of 275 patients, 6.9% experienced major harm (phlebitis, bleeding, ulceration) and 18.9% reported minor harm (pain, swelling).
- Psychological harm was reported by 6.9% of patients, with rising CEAP stage correlating with increased harm (p < 0.0001).
- QoL scores indicated a significant detriment, with median EQ-VAS of 75 and EQ-5D of 0.685.
Conclusions:
- Delaying varicose vein surgery, particularly during the pandemic, resulted in substantial patient harm, encompassing physical and psychological distress.
- The study underscores the significant negative impact of prolonged waiting times on patients' quality of life.
- Timely surgical intervention for varicose veins is crucial to prevent complications and maintain patient well-being.
Introduction:
Varicose veins (VV) negatively impact quality of life (QoL) and have risks of major complications including bleeding, ulceration and phlebitis. During the COVID-19 pandemic, the VSGBI (Vascular Society of Great Britain and Ireland) and GIRFT (Get It Right First Time) classified VVs as lowest priority for intervention.
Objective:
This study aims to determine harm caused and the impact on the QoL on patients waiting for their VVs procedures for more than 1 year.
Methods:
This was a prospective study conducted at the Norfolk and Norwich University Hospital (NNUH). Patients with VVs awaiting intervention for >1 year were included in the study. Patients with CEAP C6 disease were considered to be too high risk to be invited for treatment during the Covid-19 pandemic. Patients were sent QoL questionnaires and underwent a telephone consultation to assess harm. Both generic (EQ-VAS and EQ-5D) and disease-specific (AVVQ and CIVIQ-14) instruments were utilised. There were no control groups available for comparison.
Results:
275 patients were identified (37.1% male) with median time on waiting list of 60 weeks (IQR 56-65). 19 patients (6.9%) came to major harm, including phlebitis (3.6%), bleeding (1.8%) and ulceration (1.8%). Fifty-two patients (18.9%) had minor harm, including worsening pain (12.7%) and swelling (6.2%). 6.9% reported psychological harm. Rising CEAP stage was also associated with worsening level of harm in patients with C5-6 disease (p < 0.0001). Only 8.7% stated they would decline surgery during the pandemic. 104 QoL questionnaires were returned. Median EQ-VAS and EQ-5D was 75 (IQR: 60-85) and 0.685 (0.566-0.761), respectively. Median AVVQ score was 23.2 (14.9-31.0) and CIVIQ-14 score was 33 (21-44).ConclusionsThis study highlights the impact of delaying VVs surgery during a pandemic. A significant rate of both major and minor as well as psychological harm was reported. In addition, VVs had a significant detriment to quality of life.
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