Factors associated with delays in revascularization in patients with chronic limb-threatening ischaemia: population-based cohort study

Birmpili, P.; Johal, A.; Li, Q.; Waton, S.; Chetter, I.; Boyle, J. R.; Cromwell, D.

Abstract

Background: Prompt revascularization in patients with chronic limb-threatening ischaemia (CLTI) is important, and recent guidance has suggested that patients should undergo revascularization within 5 days of an emergency admission to hospital. The aim of this cohort study was to identify factors associated with the ability of UK vascular services to meet this standard of care.
Methods
Data on all patients admitted non-electively with CLTI who underwent open or endovascular revascularization between 2016 and 2019 were extracted from the National Vascular Registry. The primary outcome was interval between admission and procedure, analysed as a binary variable (5 days or less, over 5 days). Multivariable Poisson regression was used to examine the relationship between time to revascularization and patient and admission characteristics.
Results
The study analysed information on 11 398 patients (5973 open, 5425 endovascular), 50.6 per of whom underwent revascularization within 5 days. The median interval between admission and intervention was 5 (i.q.r. 2–9) days. Patient factors associated with increased risk of delayed revascularization were older age, greater burden of co-morbidity, non-smoking status, presentation with infection and tissue loss, and a Fontaine score of IV. Patients admitted later in the week were less likely undergo revascularization within 5 days than those admitted on Sundays and Mondays (P 

Citation

Birmpili, P., Johal, A., Li, Q., Waton, S., Chetter, I., Boyle, J. R., & Cromwell, D. (2021). Factors associated with delays in revascularization in patients with chronic limb-threatening ischaemia: population-based cohort study. British journal of surgery, 108(8), 951-959. https://doi.org/10.1093/bjs/znab039

• Journal Article Type: Article
• Acceptance Date: Jan 17, 2021
• Online Publication Date: Apr 11, 2021
• Publication Date: Aug 19, 2021
• Deposit Date: Apr 13, 2021
• Publicly Available Date: Apr 12, 2022
• Journal: The British journal of surgery
• Print ISSN: 0007-1323
• Electronic ISSN: 1365-2168
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 108
• Issue: 8
• Article Number: znab03
• Pages: 951-959
• DOI: https://doi.org/10.1093/bjs/znab039
• Keywords: Ischemia; Limb; Revascularization
• Public URL: https://hull-repository.worktribe.com/output/3751299