A Comparison Of Short Vs Long Treatment Lengths On Varicose Vein Outcomes
Halbert Bai, MPH, Jason B. Storch, BA, Jenny Chen, BA, Keva Li, BA, Kevin Chun, BA, Jay Sanghvi, MS, Adriana Pero, BA, Nithya Krishnamurthy, BA, Jinseo Kim, Yeju Kang, Anna B. Williams, Jerry Zhu, BA, Rishab R. Revankar, BA, Navindra David, BA, Samir Kamat, BA, Justin George, MD, Andrea T. Obi, MD, Windsor Ting, MD.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
OBJECTIVES: Varicose veins are common and their severity to patients is often dictated by their length. There has been no study to date that has compared the impact of short versus long treatment lengths on clinical or patient-reported outcomes. This study aimed to determine differences in degree of improvement after intervention according to two extremes of treatment length.
METHODS: All patients receiving varicose vein treatment lengths of 0 to 15 cm and 45 to 60 cm in the national Vascular Quality Initiative (2015-2021) were identified. Venous Clinical Severity Score (VCSS) and patient-reported outcomes (PROs) were compared between the two groups. PROs were measured according to a 6-point scale from no symptoms (0) to fully symptomatic (6). Categorical variables were analyzed using Chi-squared and continuous variables were compared using t-test. Univariate and multivariate logistic regression models were employed to determine odds of improvement after intervention. Multivariate analysis controlled for age, gender, race, prior varicose vein treatment, preoperative VCSS composite score, and prior DVT.
RESULTS: 26,649 patients undergoing treatment for varicose veins were identified. Short treatment length was associated with increased VCSS composite score (8.1 vs. 7.2; p<.001), number of veins treated (3.5 vs. 1.8; p<.001), and rate of prior DVT (7.1 vs. 5.8; p<.001). Short treatment length was associated with worse PROs including heaviness (2.4 vs. 2.0; p<.001), achiness (2.6 s. 2.4; p<.001), throbbing (1.7 vs. 1.5; p<.001), itching (1.5 vs. 1.2; p<.001), and work impact (2.1 vs. 1.8; p<.001). However, after treatment, patients with short treatment lengths presented with lower VCSS composite score (2.7 vs. 4.0; p<.001) and better PROs including heaviness (0.4 vs. 0.5; p<.001), achiness (0.6 vs. 0.8; p<.001), swelling (0.6 vs. 0.8; p<.001), throbbing (0.3 vs. 0.4; p<.001), itching (0.3 vs. 0.4; p<.001), and work impact (0.5 vs. 0.8; p<.001). Short treatment length was associated with greater improvement in VCSS (5.4 vs. 3.4; p<.001). After adjusting for confounders, short treatment length remained associated with improvement in VCSS composite scores after intervention (odds ratio [OR] = 1.7, 95% confidence interval [CI] = [1.5-1.9]).
CONCLUSIONS: Treatment length has a significant impact on PROs and VCSS composite scores. Compared to long treatment lengths (45-60 cm), short treatment lengths (0-15 cm) were associated with more severe superficial venous disease on initial presentation but greater improvement post-intervention.
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