1. The impact of travel distance in patient outcomes following revascularization for chronic limb-threatening ischemia.
- Author
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Mota L, Jayaram A, Wu WW, Roth EM, Darling JD, Hamdan AD, Wyers MC, Stangenberg L, Schermerhorn ML, and Liang P
- Subjects
- Humans, Retrospective Studies, Male, Female, Aged, Time Factors, Treatment Outcome, Risk Factors, Middle Aged, Health Services Accessibility, Vascular Surgical Procedures adverse effects, Vascular Surgical Procedures mortality, Chronic Limb-Threatening Ischemia surgery, Chronic Limb-Threatening Ischemia mortality, Risk Assessment, Aged, 80 and over, Length of Stay, Ischemia surgery, Ischemia mortality, Ischemia physiopathology, Ischemia diagnosis, Wound Healing, Lower Extremity blood supply, Recurrence, Chronic Disease, Amputation, Surgical, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Peripheral Arterial Disease surgery, Peripheral Arterial Disease mortality, Peripheral Arterial Disease physiopathology, Peripheral Arterial Disease diagnosis, Travel, Vascular Patency, Limb Salvage
- Abstract
Background: Patient travel distance to the hospital is a key metric of individual and social disadvantage and its impact on the management and outcomes following intervention for chronic limb-threatening ischemia (CLTI) is likely underestimated. We sought to evaluate the effect of travel distance on outcomes in patients undergoing first-time lower extremity revascularization at our institution., Methods: We retrospectively reviewed all consecutive patients undergoing first-time lower extremity revascularization, both endovascular and open, for CLTI from 2005 to 2014. Patients were stratified into 2 groups based on travel distance from home to hospital greater than or less than 30 miles. Outcomes included reintervention, major amputation, restenosis, primary patency, wound healing, length of stay, length of follow-up and mortality. Kaplan-Meier estimates were used to determine event rates. Logistic and cox regression was used to evaluate for an independent association between travel distance and these outcomes., Results: Of the 1293 patients were identified, 38% traveled >30 miles. Patients with longer travel distances were younger (70 years vs 73 years; P = .001), more likely to undergo open revascularization (65% vs 41%; P < .001), and had similar Wound, Ischemia, foot Infection stages (P = .404). Longer distance travelled was associated with an increase in total hospital length of stay (9.6 days vs 8.6 days; P = .031) and shorter total duration of postoperative follow-up (2.1 years vs 3.0 years; P = .001). At 5 years, there was no definitive difference in the rate of restenosis (hzard ratio [HR], 1.3; 95% confidence interval [CI], 0.91-1.9; P = .155) or reintervention (HR, 1.4; 95% CI, 0.96-2.1; P = .065), but longer travel distance was associated with an increased rate of major amputation (HR, 2.1; 95% CI, 1.2-3.7; P = .011), and death (HR, 1.6; 95% CI, 1.2-2.2; P = .002). Longer travel distance was also associated with higher rate of nonhealing wounds (HR, 2.3; 95% CI, 1.5-3.5; P = .001)., Conclusions: Longer patient travel distance was found to be associated with a lower likelihood of limb salvage and survival in patients undergoing first-time lower extremity revascularization for CLTI. Understanding and addressing the barriers to discharge, need for multidisciplinary follow-up, and appropriate postoperative wound care management will be key in improving outcomes at tertiary care regional specialty centers., Competing Interests: Disclosures None., (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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