• Br J Surg · Jul 2022

    Delays to revascularization for patients with chronic limb-threatening ischaemia.

    • Qiuju Li, Panagiota Birmpili, Amundeep S Johal, Sam Waton, Arun D Pherwani, Jonathan R Boyle, and David A Cromwell.
    • Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
    • Br J Surg. 2022 Jul 15; 109 (8): 717726717-726.

    BackgroundVascular services in England are organized into regional hub-and-spoke models, with hubs performing arterial surgery. This study examined time to revascularization for chronic limb-threatening ischaemia (CLTI) within and across different care pathways, and its association with postrevascularization outcomes.MethodsThree inpatient and four outpatient care pathways were identified for patients with CLTI undergoing revascularization between April 2015 and March 2019 using Hospital Episode Statistics data. Differences in times from presentation to revascularization across care pathways were analysed using Cox regression. The relationship between postoperative outcomes and time to revascularization was evaluated by logistic regression.ResultsAmong 16 483 patients with CLTI, 9470 had pathways starting with admission to a hub or spoke hospital, whereas 7013 (42.5 per cent) were first seen at outpatient visits. Among the inpatient pathways, patients admitted to arterial hubs had shorter times to revascularization than those admitted to spoke hospitals (median 5 (i.q.r. 2-10) versus 12 (7-19) days; P < 0.001). Shorter times to revascularization were also observed for patients presenting to outpatient clinics at arterial hubs compared with spoke hospitals (13 (6-25) versus 26 (15-35) days; P < 0.001). Within most care pathways, longer delays to revascularizsation were associated with increased risks of postoperative major amputation and in-hospital death, but the effect of delay differed across pathways.ConclusionFor patients with CLTI, time to revascularization was influenced by presentation to an arterial hub or spoke hospital. Generally, longer delays to revascularization were associated with worse outcomes, but the impact of delay differed across pathways.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

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