{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:27:37Z","timestamp":1790162857424,"version":"4.1.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T00:00:00Z","timestamp":1652227200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NHS England"},{"DOI":"10.13039\/100015846","name":"the Welsh Government","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015846","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Vascular services in England are organized into regional hub-and-spoke models, with hubs performing arterial surgery. This study examined time to revascularization for chronic limb-threatening ischaemia (CLTI) within and across different care pathways, and its association with postrevascularization outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Three inpatient and four outpatient care pathways were identified for patients with CLTI undergoing revascularization between April 2015 and March 2019 using Hospital Episode Statistics data. Differences in times from presentation to revascularization across care pathways were analysed using Cox regression. The relationship between postoperative outcomes and time to revascularization was evaluated by logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 16\u2009483 patients with CLTI, 9470 had pathways starting with admission to a hub or spoke hospital, whereas 7013 (42.5 per cent) were first seen at outpatient visits. Among the inpatient pathways, patients admitted to arterial hubs had shorter times to revascularization than those admitted to spoke hospitals (median 5 (i.q.r. 2\u201310) versus 12 (7\u201319) days; P\u2009&amp;lt;\u20090.001). Shorter times to revascularization were also observed for patients presenting to outpatient clinics at arterial hubs compared with spoke hospitals (13 (6\u201325) versus 26 (15\u201335) days; P\u2009&amp;lt;\u20090.001). Within most care pathways, longer delays to revascularizsation were associated with increased risks of postoperative major amputation and in-hospital death, but the effect of delay differed across pathways.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>For patients with CLTI, time to revascularization was influenced by presentation to an arterial hub or spoke hospital. Generally, longer delays to revascularization were associated with worse outcomes, but the impact of delay differed across pathways.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjs\/znac109","type":"journal-article","created":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T20:11:03Z","timestamp":1647979863000},"page":"717-726","source":"Crossref","is-referenced-by-count":39,"title":["Delays to revascularization for patients with chronic limb-threatening ischaemia"],"prefix":"10.1093","volume":"109","author":[{"given":"Qiuju","family":"Li","sequence":"first","affiliation":[{"name":"Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine , London , UK"},{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiota","family":"Birmpili","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England , London , UK"},{"name":"Hull York Medical School , Hull , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5050-1861","authenticated-orcid":false,"given":"Amundeep S","family":"Johal","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Waton","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun D","family":"Pherwani","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust , Stoke-on-Trent , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R","family":"Boyle","sequence":"additional","affiliation":[{"name":"Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust & Department of Surgery, University of Cambridge , Cambridge , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"Cromwell","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine , London , UK"},{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,5,11]]},"reference":[{"key":"2023063010292717900_znac109-B1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.ejvs.2019.05.006","article-title":"Global vascular guidelines on the management of chronic limb-threatening ischemia","volume":"58","author":"Conte","year":"2019","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2023063010292717900_znac109-B2","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.ejvs.2006.09.024","article-title":"Inter-society consensus for the management of peripheral arterial disease (TASC II)","volume":"33","author":"Norgren","year":"2007","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2023063010292717900_znac109-B3","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.jvs.2009.08.073","article-title":"Critical limb ischemia","volume":"51","author":"Varu","year":"2010","journal-title":"J Vasc Surg"},{"key":"2023063010292717900_znac109-B4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.2147\/VHRM.S125065","article-title":"Critical limb ischemia: current challenges and future prospects","volume":"14","author":"Uccioli","year":"2018","journal-title":"Vasc Health Risk Manag"},{"key":"2023063010292717900_znac109-B5","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1097\/SLA.0000000000002965","article-title":"Toward a consensus on centralization in surgery","volume":"268","author":"Vonlanthen","year":"2018","journal-title":"Ann Surg"},{"key":"2023063010292717900_znac109-B6","volume-title":"The Reconfiguration of Clinical Services: What is the Evidence?","author":"Imison","year":"2014"},{"key":"2023063010292717900_znac109-B7","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1002\/bjs.5710","article-title":"Meta-analysis and systematic review of the relationship between volume and outcome in abdominal aortic aneurysm surgery","volume":"94","author":"Holt","year":"2007","journal-title":"Br J Surg"},{"key":"2023063010292717900_znac109-B8","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.ejvs.2007.01.014","article-title":"Meta-analysis and systematic review of the relationship between hospital volume and outcome following carotid endarterectomy","volume":"33","author":"Holt","year":"2007","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2023063010292717900_znac109-B9","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1002\/bjs.7089","article-title":"Systematic review and meta-analysis of the relationship between hospital volume and outcome for lower limb arterial surgery","volume":"97","author":"Awopetu","year":"2010","journal-title":"Br J Surg"},{"key":"2023063010292717900_znac109-B10","article-title":"Provision of Services for Patients with Vascular Disease 2018","author":"Vascular Society of Great Britain and Ireland."},{"key":"2023063010292717900_znac109-B11","first-page":"50","article-title":"The strategy that will fix health care","volume":"91","author":"Porter","year":"2013","journal-title":"Harv Bus Rev"},{"key":"2023063010292717900_znac109-B12","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.ejvs.2020.07.015","article-title":"Outcomes for angioplasty and bypass lower limb revascularisation procedures for limb salvage in England: findings from the Getting It Right First Time programme","volume":"60","author":"Gray","year":"2020","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2023063010292717900_znac109-B13","article-title":"UK Carotid Endarterectomy Audit Round 4 Public Report","author":"Vascular Services Quality Improvement Programme"},{"key":"2023063010292717900_znac109-B14","volume-title":"National Vascular Registry. Annual Report","author":"Waton","year":"2018"},{"key":"2023063010292717900_znac109-B15","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.jvs.2019.08.229","article-title":"A systematic review investigating the identification, causes, and outcomes of delays in the management of chronic limb-threatening ischemia and diabetic foot ulceration","volume":"71","author":"Nickinson","year":"2020","journal-title":"J Vasc Surg"},{"key":"2023063010292717900_znac109-B16","article-title":"A Best Practice Clinical Care Pathway for Peripheral Arterial Disease","author":"Vascular Society of Great Britain and Ireland."},{"key":"2023063010292717900_znac109-B17","article-title":"The English indices of deprivation, 2015","author":"Communities and Local Government."},{"key":"2023063010292717900_znac109-B18","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1002\/bjs.6930","article-title":"Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson Score","volume":"97","author":"Armitage","year":"2010","journal-title":"Br J Surg"},{"key":"2023063010292717900_znac109-B19","first-page":"10","article-title":"sed9: Symmetric nearest neighbor linear smoothers","author":"Sasieni"},{"key":"2023063010292717900_znac109-B20","first-page":"285","article-title":"sed9 2: Symmetric nearest neighbor linear smoothers","volume":"5","author":"Sasieni","year":"2005","journal-title":"Stata J"},{"key":"2023063010292717900_znac109-B21","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1111\/dme.13653","article-title":"Barriers to foot care in patients with diabetes as identified by healthcare professionals","volume":"35","author":"Pankhurst","year":"2018","journal-title":"Diabet Med"},{"key":"2023063010292717900_znac109-B22","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ejvs.2016.10.023","article-title":"Analysis of the elective treatment process for critical limb ischaemia with tissue loss: diabetic patients require rapid revascularisation","volume":"53","author":"Noronen","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2023063010292717900_znac109-B23","volume-title":"National Vascular Registry. Annual Report","author":"Waton","year":"2020"},{"key":"2023063010292717900_znac109-B24","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.ejvs.2020.12.007","article-title":"Does the introduction of a vascular limb salvage service improve one year amputation outcomes for patients with chronic limb-threatening ischaemia?","volume":"61","author":"Nickinson","year":"2021","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2023063010292717900_znac109-B25","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1093\/eurheartj\/ehv006","article-title":"Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence","volume":"36","author":"Reinecke","year":"2015","journal-title":"Eur Heart J"},{"key":"2023063010292717900_znac109-B26","volume-title":"National Vascular Registry. Annual Report","author":"Waton","year":"2021"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/109\/8\/717\/50747672\/znac109.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/109\/8\/717\/50747672\/znac109.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T10:30:07Z","timestamp":1688121007000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/109\/8\/717\/6583556"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,11]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,5,11]]},"published-print":{"date-parts":[[2022,7,15]]}},"URL":"https:\/\/doi.org\/10.1093\/bjs\/znac109","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,8,1]]},"published":{"date-parts":[[2022,5,11]]}}}