Delays to revascularization for patients with chronic limb-threatening ischaemia.
Delays to revascularization for patients with chronic limb-threatening ischaemia.
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DOI：
10.1093/bjs/znac109
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发表时间：
2022-07-15
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影响因子：
--
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英格兰的血管服务被组织成区域性的轴辐模型，中心进行动脉手术。本研究检查了不同护理路径内和跨不同护理路径的慢性肢体威胁性缺血（CLTI）的血运重建时间及其与血运重建后结局的相关性。使用医院事件统计数据，确定了2015年4月至2019年3月期间接受血运重建的CLTI患者的3种住院和4种门诊治疗途径。使用考克斯回归分析了不同护理途径之间从就诊到血运重建的时间差异。通过logistic回归分析评价术后结局与血运重建时间之间的关系。在16483例CLTI患者中，9470例患者从中心或辐射医院入院开始，而7013例（42.5%）首次出现在门诊就诊。在住院患者中，动脉枢纽患者的血运重建时间短于分支医院患者（中位数5（i.q.r. 2-10天组与12天组（7-19天组）比较，P < 0.001。与分支医院相比，动脉枢纽门诊患者的血运重建时间也较短（13（6-25）天vs 26（15-35）天; P < 0.001）。在大多数护理途径中，血运重建延迟时间较长与术后大截肢和院内死亡风险增加相关，但延迟的影响在不同途径中存在差异。对于CLTI患者，到血运重建的时间受到动脉枢纽或分支医院的影响。一般来说，血运重建延迟时间越长，结局越差，但延迟的影响在不同途径之间存在差异。本研究使用2015年4月至2019年3月期间的医院事件统计数据，在血管服务网络的区域轴辐模型内的不同护理路径内和跨不同护理路径，检查了慢性肢体威胁性缺血（CLTI）患者从就诊到血运重建的时间。数据表明，CLTI患者的血运重建时间受动脉枢纽或分支医院的影响。这项研究还表明，一般来说，血运重建延迟时间较长与大截肢和住院死亡的血运重建后结局较差相关，但延迟的影响在不同的护理途径中存在差异。
Vascular 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. Three 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. Among 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. For 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. This study examined time to revascularization from presentation for patients with chronic limb-threatening ischaemia (CLTI) within and across different care pathways within the reginal hub-and-spoke models of vascular service networks, using Hospital Episode Statistics data between April 2015 and March 2019. The data suggested that, among the patients with CLTI, time to revascularization was influenced by presentation to an arterial hub or spoke hospital. This study also suggested that, generally, longer delays to revascularization were associated with worse postrevascularization outcomes of major amputation and in-hospital death, but the impact of delay differed across care pathways.
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