Journal of vascular surgery. Venous and lymphatic disorders | 2021
Delayed Referral of Venous Ulcers Increases Resource Utilization.
Abstract
OBJECTIVE\nVenous insufficiency is often not readily recognized as a contributing etiology to non-healing wounds by non-vascular surgery specialists, potentially delaying appropriate treatment to achieve wound healing and increasing health care costs. The objective of this study is to understand the time and resources used prior to definitive treatment of venous ulcers.\n\n\nMETHODS\nA single-institution retrospective chart review of C6 patients undergoing radiofrequency saphenous and perforator vein ablation (RFA) between May 2016 and January 2018 identified 56 patients with 67 diseased limbs. Numbers of inpatient, ER, and wound care visits, and time to vein ablation from initial evaluation of the ulceration by a healthcare provider were collected. Demographics, comorbidities, prior venous interventions, wound characteristics, duplex imaging, and available wound healing follow-up through July 2018 were assessed in all patients.\n\n\nRESULTS\nOf the 67 limbs examined, there were 588 total healthcare visits for wound assessment prior to seeing a vascular surgeon, with 413 visits from a wound care center (70% of all visits). Other specialty visits included emergency medicine (17.9% of limbs) and rheumatology (22.4% of limbs). Six patients (9 limbs) were admitted to inpatient services for their ulceration. Overall, patients were seen an average of 8.6 ± 9.7 times for their ulcer with the wound center prior to determination of contributing venous etiology and subsequent treatment. These visits translated to a median of 230 days [86.5-1088 days] between first identification of the ulcer by healthcare providers and subsequent accurate diagnosis and definitive treatment of their venous disease with RFA. After intervention, 18.64% of limbs were healed at 1 month, 33.92% were healed at 3 months, 50% were healed at 6 months, and 82.92% were healed by 12 months.\n\n\nCONCLUSIONS\nEarlier and accurate diagnosis of venous contribution to ulcers and subsequent appropriate treatment of venous etiologies in wound formation by a vascular venous specialist may significantly improve healing and minimize resources.