Conclusions
Admissions for inpatient management of VLUs have fallen after beginning aggressive endovenous treatment of venous reflux in a dedicated one-stop see-and-treat clinic for these patients. As a result, bed-day usage has also fallen, leading to cost savings.
What is already known about this topic? Early venous reflux ablation can improve the time it takes for venous leg ulcers to heal
What does this article add?
This article shows an association between improved access to specialist services for venous leg ulcer management, including early ablation, and a reduction in inpatient admissions for ulcer related complications
Introduction
Venous ulceration poses a massive economic burden on health services1-4. Compression therapy has been shown to aid the healing of venous ulcers5, 6. It is time consuming for patients and practitioners however and requires significant community support.
Superficial venous reflux (varicose veins) is frequently present in patients with venous leg ulcers7, and surgical treatment of varicose veins, in combination with compression, has been shown to improve the rate of ulcer recurrence. However, the ESCHAR trial did not show any benefit in ulcer healing from surgery8, 9. Therefore, some guidelines only recommend surgery to reduce recurrence10 and commonly patients have surgical intervention after their ulcers are healed. Numerous observational studies11-14 and the EVRA (Early Venous Reflux Ablation) Trial15 have shown that endovenous treatment of varicose veins may improve ulcer healing, and so in recent years guidelines have begun to reflect this.16, 17
In specialist practice it is uncommon for patients to be admitted for management of venous ulcers, and it is typically dealt with in an outpatient setting unless there is superimposed infection. It is not unusual however for elderly, comorbid patients to be referred to emergency departments with VLUs, even when infection is not necessarily the issue, and often leads to admission in non-specialist centres. In this population, this can lead to prolonged inpatient stays for patients who could otherwise be managed effectively at home. An alternative pathway, avoiding emergency department referrals and providing rapid access to specialist care might reduce these admissions.
We introduced a ‘one-stop see and treat’ clinic for venous leg ulcer (VLU) patients in 2016. We aimed to determine how this service impacted upon unplanned hospital admissions for venous ulceration.