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Unpacking The Gap: How Service Type Impacts Patient Care And Outcomes For Chronic Limb Threatening Ischemia
Jayne Raven Rice, M.D1, Sankrit Kapoor, BS
1, Vikki Rueda-Juarez, BS
2, Christianah Alli, MS
2, Julia Glaser, MD
1, Darren Schneider, MD
1, Elizabeth Genovese, MD
1.
1University of Pennsylvania, Philadelphia, PA, USA,
2Drexel University College of Medicine, Philadelphia, PA, USA.
OBJECTIVES:Chronic limb threatening ischemia (CLTI) patients are medically complex at a high risk of limb loss who are often admitted to both medical and surgical services. We investigated differences in perioperative management and outcomes of patients admitted to the vascular surgery versus medicine service.
METHODS:A single institution, retrospective chart review was conducted on CLTI patients admitted between 2021-2023 who underwent a revascularization procedure with vascular surgery. Univariable, multivariable and Kaplan Meier analyses were conducted to compare perioperative management and outcomes based on service type to identify factors associated with management and outcomes.
RESULTS:We identified 392 patients, with 82 (20.9%) admitted to medicine versus 310 (79.1%) to vascular surgery. Tissue loss was reported in 92.7% patients on medicine versus 65.5% on vascular (p<0.001). Rates of medium or high WiFI categories were present in 79.3% of medicine patients compared to 53.9 % of vascular patients (p<0.001).
Only 17 (20.7%) patients on the medicine service had a primary diagnosis other than CLTI. Medicine patients had longer delays to the operating room and longer lengths of stay (time to the OR: 7.9 days vs 2.2 days, p<0.001; LOS: 22.1 days vs 9.7 days p<0.001). On multivariable analysis concurrent podiatry procedure, service type, more than 2 consult services, open revascularization, discharge to other than home, history of COPD and ambulation with assistance contributed to prolonged LOS greater than 7 days (table 1). Service type and multiple consult services contributed to a delay to the operating greater than 72 hours. (Medicine service: OR:11.9, p< 0.001, consults: OR: 3.41, p<0.001). There were no significant differences in postoperative complications or major limb loss by service type. There was no difference in 30 day and 3-month admission rate, long-term mortality or limb loss between the two groups. Medicine patients were more likely to be lost to follow-up with vascular surgery as an outpatient (35.1% vs 7.7%, p<0.001).
CONCLUSIONS: Hospitalized CLTI patients on a vascular surgery service have increased revascularization efficiency, shorter hospital stays, and better adherence to outpatient follow-up, even when accounting for comorbidities and revascularization type.
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