The effects of high quality team medicine on outcomes of chronic limb-threatening ischemia patients with infrapopliteal bypass.

IF 1 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular Pub Date : 2024-12-01 Epub Date: 2023-08-08 DOI:10.1177/17085381231194959

Taira Kobayashi, Masaki Hamamoto, Takanobu Okazaki, Ryo Okusako, Misa Hasegawa, Kazufumi Ishida, Tomoaki Honma, Masamichi Ozawa, Shinya Takahashi

{"title":"The effects of high quality team medicine on outcomes of chronic limb-threatening ischemia patients with infrapopliteal bypass.","authors":"Taira Kobayashi, Masaki Hamamoto, Takanobu Okazaki, Ryo Okusako, Misa Hasegawa, Kazufumi Ishida, Tomoaki Honma, Masamichi Ozawa, Shinya Takahashi","doi":"10.1177/17085381231194959","DOIUrl":null,"url":null,"abstract":"Objectives: A team approach for treatment of patients with CLTI is used worldwide. However, the quality of team medicine is a concern. The Global Vascular Guidelines provide recommendations for high quality team medicine, but there is limited knowledge of the significance of team quality in CLTI treatment. The objective of this study is to evaluate the effects of team quality on clinical outcomes after infrapopliteal bypass.Methods: A retrospective analysis was performed in 337 patients who underwent 414 infrapopliteal bypasses under a team medicine approach at a single center between 2009 and 2021. In 2017, team medicine was reorganized for improvement of quality. Comparisons were made between before (Group 1; 160 patients, 195 limbs) and after (Group 2; 177 patients, 219 limbs) reorganization. The primary endpoints were limb salvage and wound healing after infrapopliteal bypass.Results: The patients included 227 males (67%) and had a median age of 76 [68-83] years. Diabetes mellitus was present in 67% and end-stage renal disease with hemodialysis in 37%. The follow-up rate was 96% in a mean follow-up period of 31±30 months. The 3-year limb salvage rate was significantly lower in Group 1 (before reorganization) than in Group 2 (after reorganization) (84% vs 95%, p = .001). The wound healing rates in the whole cohort were 72% at 6 months and 85% at 12 months, with no significant differences between the groups. In multivariate analysis, the risk factors for major amputation were treatment before reorganization (HR 2.68; p = .017), hemodialysis (HR 2.27; p = .017), and non-ambulatory status (HR 2.63; p = .005).Conclusions: A reorganized team approach with the goal of higher quality was independently associated with reduced major amputation for patients with CLTI treated with infrapopliteal bypass. This result indicates the importance of a high quality team approach for success of this treatment.","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"1202-1211"},"PeriodicalIF":1.0000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Vascular","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17085381231194959","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/8/8 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: A team approach for treatment of patients with CLTI is used worldwide. However, the quality of team medicine is a concern. The Global Vascular Guidelines provide recommendations for high quality team medicine, but there is limited knowledge of the significance of team quality in CLTI treatment. The objective of this study is to evaluate the effects of team quality on clinical outcomes after infrapopliteal bypass.

Methods: A retrospective analysis was performed in 337 patients who underwent 414 infrapopliteal bypasses under a team medicine approach at a single center between 2009 and 2021. In 2017, team medicine was reorganized for improvement of quality. Comparisons were made between before (Group 1; 160 patients, 195 limbs) and after (Group 2; 177 patients, 219 limbs) reorganization. The primary endpoints were limb salvage and wound healing after infrapopliteal bypass.

Results: The patients included 227 males (67%) and had a median age of 76 [68-83] years. Diabetes mellitus was present in 67% and end-stage renal disease with hemodialysis in 37%. The follow-up rate was 96% in a mean follow-up period of 31±30 months. The 3-year limb salvage rate was significantly lower in Group 1 (before reorganization) than in Group 2 (after reorganization) (84% vs 95%, p = .001). The wound healing rates in the whole cohort were 72% at 6 months and 85% at 12 months, with no significant differences between the groups. In multivariate analysis, the risk factors for major amputation were treatment before reorganization (HR 2.68; p = .017), hemodialysis (HR 2.27; p = .017), and non-ambulatory status (HR 2.63; p = .005).

Conclusions: A reorganized team approach with the goal of higher quality was independently associated with reduced major amputation for patients with CLTI treated with infrapopliteal bypass. This result indicates the importance of a high quality team approach for success of this treatment.

查看原文本刊更多论文

高质量团队医疗对腘绳肌下搭桥术慢性肢体缺血患者疗效的影响。

目标：治疗 CLTI 患者的团队方法已在全球范围内得到广泛应用。然而，团队医疗的质量令人担忧。全球血管指南》为高质量的团队医疗提供了建议，但人们对 CLTI 治疗中团队质量的重要性了解有限。本研究的目的是评估团队质量对下腔静脉搭桥术后临床结果的影响：2009年至2021年期间，337名患者在一家中心接受了414例团队医疗方法下的髂腹下搭桥术，研究人员对这些患者进行了回顾性分析。2017 年，团队医疗进行了重组，以提高质量。对重组前（第1组；160名患者，195条肢体）和重组后（第2组；177名患者，219条肢体）进行了比较。主要终点是髂腹下搭桥术后的肢体挽救和伤口愈合：患者中有 227 名男性（67%），中位年龄为 76 [68-83] 岁。67%的患者患有糖尿病，37%的患者患有终末期肾病，需要进行血液透析。平均随访时间为 31±30 个月，随访率为 96%。第1组（重组前）的3年肢体挽救率明显低于第2组（重组后）（84% vs 95%，P = .001）。整组患者的伤口愈合率在 6 个月时为 72%，12 个月时为 85%，组间无明显差异。在多变量分析中，大截肢的风险因素为重组前的治疗（HR 2.68; p = .017）、血液透析（HR 2.27; p = .017）和非行走状态（HR 2.63; p = .005）：结论：以提高质量为目标的重组团队方法与减少采用腘绳肌下旁路术治疗的 CLTI 患者的大截肢率密切相关。这一结果表明，高质量的团队方法对这种治疗方法的成功非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Vascular 医学-外周血管病

CiteScore

2.30

自引率

9.10%

发文量

196

审稿时长

6-12 weeks

期刊介绍： Vascular provides readers with new and unusual up-to-date articles and case reports focusing on vascular and endovascular topics. It is a highly international forum for the discussion and debate of all aspects of this distinct surgical specialty. It also features opinion pieces, literature reviews and controversial issues presented from various points of view.