Specialist Palliative Care Service Involvement and Prognostic Factors in Patients Presenting With Acute Limb Ischaemia to Waikato Hospital, Hamilton, New Zealand: A Retrospective Review.

Abstract

Background: There is significant morbidity and mortality associated with acute limb ischaemia (ALI) and prognostication is complex. Current literature reports underutilisation of specialist palliative care (SPC) and lack of prognostic indicators to guide decision-making and referral.

Objective/aim: The aim of this study is to review and analyse demographic, clinical and mortality data for a cohort of ALI patients to determine potential prognostic indicators, SPC referral patterns and SPC services received.

Method: Retrospective clinical record reviews for a cohort of ALI patients referred to the Waikato Hospital Vascular Surgery team in a specified time period. This included laboratory, imaging and death documentation and functional status at baseline and ALI diagnosis.

Results: One hundred fifty-five ALI patients were identified of whom 140 met the inclusion criteria. A 30-day mortality was 19% and 1-year mortality was 31% for the study cohort. Lactate > 2.2 mmol//L, albumin < 27 g/L Rutherford III staging and reduced functional capacity (Australia-modified Karnofsky Performance Scale score ≤ 50 at baseline and ≤ 40 at ALI diagnosis) were found to be independent predictors of mortality. Referral for SPC was 14% of the study cohort, usually late in the admission and often in the last few days of life. SPC provided a wide range of services, frequently exceeding the referral request.

Conclusion: The four independent predictors of mortality could be used to identify ALI patients with a poor prognosis, encourage earlier referral for SPC, support appropriate symptom management and enable discussions on patient priorities.