Abstract Objective To determine whether the introduction of a one-stop see and treat clinic offering early reflux ablation for Venous Leg Ulcer (VLU) patients in July 2016 has affected rates of unplanned inpatient admissions due to venous ulceration. Design Review of inpatient admission data and analysis of related costs. Materials The Hospital Inpatient Enquiry collects data from acute public hospitals in Ireland on admissions and discharges, coded by diagnosis and acuity. This was the primary source of all data relating to admissions and length of stay. Costs were calculated from data published by the Health Service Executive in Ireland on average costs per inpatient stay for given diagnosis codes. Methods Data were collected on admission rates, length of stay, overall bed day usage, and costs across a four-year period; the two years since the introduction of the rapid access clinic, and the two years immediately prior as a control. Results 218 patients admitted with VLUs accounted for a total of 2,529 inpatient bed-days, with 4.5(2-6) unplanned admissions, and a median hospital stay of 7(4-13) days per month. Median unplanned admissions per month decreased from 6(2.5-8.5) in the control period, to 3.5(2-5) after introduction of the clinic p=.040. Bed-day usage was significantly reduced from median 62.5(27-92.5), to 36.5(21-44) bed-days per month (p=.035), though length of stay remained unchanged (p=.57). Cost of unplanned inpatient admissions fell from median \euro33,336.25(\euro14,401.26-\euro49,337.65) per month to \euro19,468.37(\euro11,200.98-\euro22,401.96) (p=.03). Conclusions Admissions for inpatient management of VLUs have fallen after beginning aggressive endovenous treatment of venous reflux in a dedicated one-stop see-and-treat clinic for these patients. As a result, bed-day usage has also fallen, leading to cost savings.
Background: Revascularization has been considered the gold standard treatment for critical limb ischemia (CLI). Due to the high morbidity and mortality associated with intervention, evidence has emerged recently supporting the suitability of conservative management as a primary option to achieve amputation-free survival (AFS) in CLI patients even when revascularization is technically feasible. Methods: A prospective database of CLI patients was developed during pre-screening of patients for a phase 1 stem cell therapy clinical trial. The overall survival (OS) and AFS rates for patients treated with revascularization were compared to those treated conservatively. Statistical significance was set as p value < 0.05. OS and AFS for the two groups were estimated by Kaplan-Meier survival curves. Results: Patients in the conservative group were more likely to have Rutherford Class 5 and be diabetic while they were less likely to be active smokers or have hyperlipidemia (Table 1). There were no significant differences between the two groups in mortality, amputation, overall AFS or one-year AFS rates. Kaplan-Meier cumulative OS and AFS over the 3 years follow-up period of the study demonstrated significant differences between the conservative and revascularization groups (Log Rank: 0.031 & 0.045; respectively). This statistical significance was not detected when one-year AFS was evaluated (Log Rank 0.096). Conclusion: Conservative management can be a suitable management option to achieve one-year AFS for some CLI patients. Further studies are needed to identify robust clinical criteria for identifying patients who will benefit from conservative management.