Variation in treatment and outcomes for patients with chronic limb‐threatening ischaemia in New South Wales, Australia

Abstract

Background Chronic limb‐threatening ischaemia (CLTI) carries significant amputation and mortality risks. Australian population‐based outcomes for CLTI are inadequately known. This study aimed to distinguish factors associated with outcomes in the first 2 years after CLTI surgery. Methods By linking routinely collected health administrative and mortality data from New South Wales, this population‐based cohort study identified patients with ischaemic rest pain, gangrene or ulceration undergoing vascular surgery in public hospitals between 2010 and 2012. The primary outcome was 2‐year amputation‐free survival (AFS), and secondary outcomes included readmission and reoperation rates. Multivariable regression analysis identified prognostic factors adjusted for patient, hospital and geographic factors. Results Primary CLTI surgery was performed on 4898 patients. Almost half the cohort had minor amputations without concurrent revascularization (2398, 49%), and the remaining patients had open (652, 13%) or endovascular (1848, 38%) surgery. At 2‐years, the AFS rate was 72%. Significant disparity was seen between age groups, with the 2‐year AFS 71% in patients aged 75 years or older, compared to 95% in patients aged less than 75 years (P < 0.001). Place of residence or hospital training status did not significantly influence AFS or readmission, but non‐training hospitals had higher rates of reoperation. Conclusion This population‐based cohort study demonstrated variable outcomes for patients with CLTI, particularly with respect to older age, admission acuity and comorbidity. Results may guide service improvements however further research is needed into how population‐wide health initiatives can address age‐related disparities in CLTI.

Disparities in Advanced Peripheral Arterial Disease Presentation by Socioeconomic Status

“…This The outcomes examined in these metrics of advanced presentation for PAD have a significant impact on patient quality of life. In Australia, emergency admissions with PAD have worse post-operative outcomes [23]. Most amputations for PAD are preceded by foot ulceration [24], and lower limb amputations are associated with significantly decreased quality of life, increased morbidity, mortality, and healthcare costs [25].…”

Chronic limb‐threatening ischaemia and confronting amputation: A Heideggerian derived understanding of Being‐with and discourse

“…Despite more options for revascularisation, amputation for CLTI is increasing, with a recent review reporting 15%-20% of patients undergo amputation within 1 year of the onset of CLTI (Duff et al, 2019). In a large Australian population-based cohort study of CLTI outcomes 2 years after non-major amputation surgery (open or endovascular revascularisation, debridement or minor amputation), morbidity and mortality were significant, reporting 28.3% for CLTI mortality, 32.8% for perioperative complications, 47% for reoperation and subsequent major amputations at 3.6% (Choy et al, 2021).…”

“…Despite more options for revascularisation, amputation for CLTI is increasing, with a recent review reporting 15%–20% of patients undergo amputation within 1 year of the onset of CLTI (Duff et al, 2019). In a large Australian population‐based cohort study of CLTI outcomes 2 years after non‐major amputation surgery (open or endovascular revascularisation, debridement or minor amputation), morbidity and mortality were significant, reporting 28.3% for CLTI mortality, 32.8% for perioperative complications, 47% for reoperation and subsequent major amputations at 3.6% (Choy et al, 2021). For Australians with CLTI proceeding to amputation, the scope of post‐amputation problems in a case series review found in‐hospital mortality of 12%, severe morbidity of 76% and 54% of live separations requiring institutional care on a permanent basis following amputation despite an average length of stay of 35.1 days (Monaro et al, 2017).…”