COVID-19 大流行对专门的血管急诊诊所的影响。

The Impact of the COVID-19 Pandemic on a Dedicated Vascular Emergency Clinic.

机构信息

Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK.

NIHR Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.

出版信息

Ann Vasc Surg. 2023 Jul;93:157-165. doi: 10.1016/j.avsg.2023.03.032. Epub 2023 Apr 5.

DOI:10.1016/j.avsg.2023.03.032

PMID:37023916

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10072978/

Abstract

BACKGROUND

Vascular Emergency Clinics (VEC) improve patient outcomes in chronic limb-threatening ischemia (CLTI). They provide a "1 stop" open access policy, whereby "suspicion of CLTI" by a healthcare professional or patient leads to a direct review. We assessed the resilience of the outpatient VEC model to the first year of the coronavirus disease (COVID-19) pandemic.

METHODS

A retrospective review of a prospectively maintained database of all patients assessed in our VEC for lower limb pathologies between March 2020 and April 2021 was performed. This was cross-referenced to national and loco-regional Governmental COVID-19 data. Individuals with CLTI were further analysed to determine Peripheral Arterial Disease-Quality Improvement Framework compliance.

RESULTS

Seven hundred and ninety one patients attended for 1,084 assessments (Male n = 484, 61%; Age 72.5 ± standard deviation 12.2 years; White British n = 645, 81.7%). In total, 322 patients were diagnosed with CLTI (40.7%). A total of 188 individuals (58.6%) underwent a first revascularization strategy (Endovascular n = 128, 39.8%; Hybrid n = 41, 12.7%; Open surgery n = 19, 5.9%; Conservative n = 134, 41.6%). Major lower limb amputation rate was 10.9% (n = 35) and mortality rate was 25.8% (n = 83) at 12 months of follow-up. Median referral to assessment time was 3 days (interquartile range: 1-5). For the nonadmitted patient with CLTI, the median assessment to intervention was 8 days (interquartile range: 6-15) and median referral to intervention time of 11 days (11-18).

CONCLUSIONS

The VEC model has demonstrated strong resilience to the COVID-19 pandemic with rapid treatment timelines maintained for patients with CLTI.

摘要

背景

血管急症诊所（VEC）改善了慢性肢体威胁性缺血（CLTI）患者的预后。它们提供了“一站式”的开放准入政策，即医疗保健专业人员或患者对 CLTI 的“怀疑”会直接进行评估。我们评估了门诊 VEC 模式在冠状病毒病（COVID-19）大流行第一年的适应能力。

方法

对 2020 年 3 月至 2021 年 4 月期间在我们的 VEC 中评估下肢病变的所有患者的前瞻性维护数据库进行了回顾性分析。这与国家和地方政府的 COVID-19 数据进行了交叉参考。进一步分析了 CLTI 患者，以确定外周动脉疾病质量改进框架的合规性。

结果

791 名患者接受了 1084 次评估（男性 n=484，61%；年龄 72.5±标准偏差 12.2 岁；白种英国人 n=645，81.7%）。共有 322 名患者被诊断为 CLTI（40.7%）。共有 188 人（58.6%）接受了首次血管重建策略（血管内 n=128，39.8%；杂交 n=41，12.7%；开放手术 n=19，5.9%；保守治疗 n=134，41.6%）。12 个月随访时，主要下肢截肢率为 10.9%（n=35），死亡率为 25.8%（n=83）。从转诊到评估的中位时间为 3 天（四分位间距：1-5）。对于非住院的 CLTI 患者，评估到干预的中位时间为 8 天（四分位间距：6-15），转诊到干预的中位时间为 11 天（11-18）。