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.