Daily Medical Liaison is Associated with Reduced Length of Stay and Complications in Selected Patients Admitted to a Regional Vascular Surgery Service.

Older adults undergoing vascular surgery are particularly vulnerable to adverse outcomes by virtue of their vascular risk factors and medical comorbidities. This study aimed to determine the impact of daily medical liaison for patients aged 65 years and older admitted to a regional vascular surgery centre. This was a descriptive before-and-after study concerning 375 patients. The primary outcome measure was length of stay (LOS). Following intervention, we identified a reduction in mean LOS in the sample from 10.75 to 7.95 days (p = 0.635, 95% Confidence Interval [CI] 0-5 days) with a statistically significant reduction in mean LOS for "stranded" patients admitted for more than seven days (mean 7.84 days reduction, p = 0.025, 95% CI for mean difference, 1.5 to 14 days). These patients did not display elevated 30-day readmission rates (12/60 to 8/72, p = 0.156, 95% CI -3% to 21%). A non-significant reduction in postoperative complications was seen in all patients in the post-intervention cohort (1.09 to 0.86 per person, p = 0.181, 95% CI -0.11 to 0.56), reaching statistical significance in emergency vascular admissions (1.81 to 0.97 complications per person, p = 0.01, mean difference = 0.84, 95% CI 0.21-1.46). This study demonstrated reduced LOS and complications in selected older patients admitted under vascular surgery after the introduction of a daily medical liaison model. These data are amongst the first to reproduce randomised controlled trial findings in a non-trial setting. Subgroup analysis indicates that patients admitted with acute pathology and those with long LOS may benefit most from medical liaison where resources are finite.

Preferences for endovascular (EVAR) or open surgical repair among patients with abdominal aortic aneurysms under surveillance.

OBJECTIVES: There is no evidence about patient preferences for treatment of abdominal aortic aneurysms (AAA) by endovascular aneurysm repair (EVAR) or open surgical repair (OSR). This study examined patient preferences for elective future aneurysm repair and factors that may influence such preferences. METHODS: Patients with small AAAs under ultrasound scan surveillance at two United Kingdom (UK) hospitals participated in a semi-structured telephone interview. Features of the two techniques were assessed with regard to their influence on the preferences of participants for EVAR or OSR, using a Likert scale. In addition, participants ranked the relative importance of 14 features against each other. RESULTS: Fifty-six out of 100 eligible participants (56%) completed the semi-structured telephone interview. Of those, 84% (47 patients) said they would prefer a future EVAR repair. Patients who expressed a preference for OSR were significantly younger. Risks of major organ failure and death were most commonly judged as important features in influencing patient preference (Likert scale score 5/5). Risk of death was also most frequently ranked above all other features. Postoperative morbidity and mortality were regarded by patients as more important than the need for surveillance and risk of long-term problems with EVAR. Type of incision and radiation exposure were both given low Likert scale scores of 1/5, and the risk of sexual dysfunction was most frequently ranked as the least important feature of either operation, out of 14 other features. CONCLUSION: When presented with detailed information about EVAR and OSR, most patients with small aneurysms would prefer EVAR.

Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein.

BACKGROUND: The purpose of this study was to investigate the long-term outcomes following stripping of the long saphenous vein during primary varicose vein surgery and to identify factors which may predict recurrence and the need for reoperation. METHODS: The original study was designed as a randomized trial of 100 patients (133 legs) who underwent saphenofemoral ligation with or without long saphenous vein stripping. After invitation 11 years later, 51 patients (74 legs) underwent clinical review and duplex imaging and completed an Aberdeen Varicose Vein Symptom Severity Score (AVVSSS). The hospital notes of the original cohort of patients were used to compile cumulative data and assess predictive factors. RESULTS: A cumulative total of 83 legs had developed clinically recurrent varicose veins by 11 years (62%). There was no statistically significant difference between the ligation-only and the stripping groups. Reoperation was required for 20 of 69 legs that underwent ligation alone compared with 7 of 64 legs that had additional long saphenous vein stripping (relative risk [RR], 2.65; 95% confidence interval, 1.20 to 5.84; P = .012). By life table analysis, freedom from reoperation at 11 years was 70% after ligation, compared with 86% after stripping ( P = .01). The presence of neovascularization (RR, 2.88; P = .15) , an incompetent superficial vessel in the thigh (RR, 3.24; P = .03) or an incompetent saphenofemoral junction on duplex imaging at 2 years postoperatively (RR, 4.89; P = .0001) increased the risk of a patient's developing clinically recurrent veins. Patients with visible recurrent varicose veins had a significantly worse AVVSSS ( P = .001). CONCLUSION: Stripping the long saphenous vein is recommended as part of routine varicose vein surgery as it reduced the risk of reoperation by 60% after 11 years, although it did not reduce the rate of visible recurrent veins.