Association Between Diagnosis-to-Limb Revascularization Time and Clinical Outcomes in Outpatients With Chronic...

Area of Science:

• Vascular Surgery
• Health Services Research
• Clinical Outcomes Research

Background:

• Chronic limb-threatening ischemia (CLTI) is a serious condition where rapid intervention is crucial.
• Delays in diagnosis-to-limb revascularization (D2L) may negatively impact patient outcomes.

Purpose of the Study:

• To investigate the association between D2L time and clinical outcomes in CLTI patients.
• To determine if shorter D2L times correlate with reduced major amputations or death.

Main Methods:

• Analysis of Medicare claims data from the CLIPPER cohort (2010-2019).
• Inclusion of over 1.1 million patients aged 66-86 diagnosed with CLTI.
• Risk-adjusted analysis of D2L time and its association with all-cause death and major lower extremity amputation.

Main Results:

• 8.8% of CLTI patients underwent outpatient endovascular revascularization within 180 days of diagnosis.
• No association found between D2L time (<30 days) and death or amputation.
• A D2L time >30 days showed a 2.5% increased risk of major amputation for every 10-day delay.

Conclusions:

• A delay exceeding 30 days from CLTI diagnosis to endovascular revascularization is linked to higher amputation risk.
• Optimizing care systems to shorten D2L time is essential for reducing major lower extremity amputations.
• Timely revascularization is critical for improving outcomes in CLTI patients.