Healthcare Disparities in Patients With Critical Limb Threatening Ischemia: Insights From the National Inpatient Sample Database 2016-2019

Torres, Christian; Ujueta, Francisco; Rogers, Everett M.; Lozier, Matthew R.; Torres-Ortiz, Hernando; Ghazzal, Amre; Beohar, Nirat

doi:10.1016/s0735-1097(23)02552-4

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“…6,7 Additionally, a recent study found that Black and American Indian/Alaska Native patients with CLTI were at the greatest risk for major amputation, followed by Hispanic individuals. 8 In appropriate patients, revascularization remains the cornerstone of CLTI treatment 1 ; however, optimising wound care is also a critical component of CLTI management. 9 In particular, management by dedicated multidisciplinary wound care teams has been associated with a trend towards shorter wound healing time, a 60% reduction in major amputations at 1 year, and a two-fold increase in amputation-free survival.…”

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confidence: 99%

Differential impact of missed initial wound clinic visit on 6‐month wound healing by race/ethnicity among patients with chronic limb‐threatening ischemia

Browder

Yohann

Filipowicz³

et al. 2023

Wound Repair Regeneration

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Chronic limb‐threatening ischemia (CLTI) is associated with significant morbidity, including major limb amputation, and mortality. Healing ischemic wounds is necessary to optimize vascular outcomes and can be facilitated by dedicated appointments at a wound clinic. This study aimed to estimate the association between successful wound care initiation and 6‐month wound healing, with specific attention to differences by race/ethnicity. This retrospective study included 398 patients with CLTI and at least one ischemic wound who scheduled an appointment at our wound clinic between January 2015 and July 2020. The exposure was the completion status of patients' first scheduled wound care appointment (complete/not complete) and the primary outcome was 6‐month wound healing (healed/not healed). The analysis focused on how this association was modified by race/ethnicity. We used Aalen‐Johansen estimators to produce cumulative incidence curves and calculated risk ratios within strata of race/ethnicity. The final adjustment set included age, revascularization, and initial wound size. Patients had a mean age of 67 ± 14 years, were 41% female, 46% non‐White and had 517 total wounds. In the overall cohort, 70% of patients completed their first visit and 34% of wounds healed within 6‐months. There was no significant difference in 6‐month healing based on first visit completion status for White/non‐Hispanic individuals [RR (95% CI) = 1.18 (0.91, 1.45); p‐value = 0.130], while non‐White individuals were roughly 3 times more likely to heal their wounds if they completed their first appointment [RR (95% CI) = 2.89 (2.66, 3.11); p‐value<0.001]. In conclusion, non‐White patients were approximately three times more likely to heal their wound in six months if they completed their first scheduled wound care appointment while White/non‐Hispanic individuals' risk of healing was similar regardless of first visit completion status. Future efforts should focus on providing additional resources to ensure minority groups with wounds have the support they need to access and successfully initiate wound care.This article is protected by copyright. All rights reserved.

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