Vascular-POPS: evidence for a new standard of care in the management of chronic limb-threatening Ischaemia.
Objective Patients with chronic limb-threatening ischaemia (CLTI) are often admitted emergently with significant comorbidity and frailty, and little time for pre-optimisation, resulting in longer hospital stays and worse outcomes. Our unit implemented a POPS (Perioperative Medicine for the Older Per...
| Publicado en: | Age & Ageing Vol. 55; no. 1; pp. 1 - 10 |
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| Autores principales: | , , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
Jan2026
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=192513129&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 192513129 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Jan2026 vid: 55 iid: 1 pid: 622 pub: Oxford University Press / USA artinfo: ui: 192513129 10.1093/ageing/afag003 ppf: 1 ppct: 9 formats: tig: atl: Vascular-POPS: evidence for a new standard of care in the management of chronic limb-threatening Ischaemia. aug: au: Khan, Assad Davies, Henry Fawcett, Lee-Ellen Darwood, Rosie Anthony, Rebecca Wallace, Tom affil: Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UKFaculty of Medicine and Health, University of Leeds, Woodhouse, Leeds LS2 9JT, UK Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK su: Interprofessional relations Cost benefit analysis Stroke Ischemia treatment Peripheral vascular disease treatment Statistical power analysis Myocardial infarction Pneumonia Nursing care plans Ischemia Data analysis Peripheral vascular diseases Frail elderly Scientific observation Kruskal-Wallis Test Logistic regression analysis Major adverse cardiovascular events Patient readmissions Hospital mortality Descriptive statistics Chi-squared test Acute kidney failure Longitudinal method Surgical complications Odds ratio Geriatric assessment Statistics Nosocomial infections Delirium Length of stay in hospitals Confidence intervals Data analysis software Perioperative care Comorbidity Proportional hazards models sug: subj: Interprofessional relations Cost benefit analysis Stroke Ischemia treatment Peripheral vascular disease treatment Statistical power analysis Myocardial infarction Pneumonia Nursing care plans Ischemia Data analysis Peripheral vascular diseases Frail elderly Scientific observation Kruskal-Wallis Test Logistic regression analysis Major adverse cardiovascular events Patient readmissions Hospital mortality Descriptive statistics Chi-squared test Acute kidney failure Longitudinal method Surgical complications Odds ratio Geriatric assessment Statistics Nosocomial infections Delirium Length of stay in hospitals Confidence intervals Data analysis software Perioperative care Comorbidity Proportional hazards models keyword: adverse event chronic limb-threatening ischemia CLTI copyrightHolder:British Geriatrics Society copyrightYear:2026 cost-effectiveness analysis frailty https://dx.doi.org/10.1093/ageing/afag003 inLanguage:en length of stay older adult older people optimisation persistent organic pollutants publisher:Oxford University Press quality of care sameAs:https://pubmed.ncbi.nlm.nih.gov/41609321/ adverse event chronic limb-threatening ischemia CLTI copyrightHolder:British Geriatrics Society copyrightYear:2026 cost-effectiveness analysis frailty https://dx.doi.org/10.1093/ageing/afag003 inLanguage:en length of stay older adult older people optimisation persistent organic pollutants publisher:Oxford University Press quality of care sameAs:https://pubmed.ncbi.nlm.nih.gov/41609321/ ab: Objective Patients with chronic limb-threatening ischaemia (CLTI) are often admitted emergently with significant comorbidity and frailty, and little time for pre-optimisation, resulting in longer hospital stays and worse outcomes. Our unit implemented a POPS (Perioperative Medicine for the Older Person undergoing Surgery) service, incorporating the comprehensive geriatric assessment (CGA) to optimise patients. This study assesses its effect on non-elective CLTI inpatients. Methods This is a prospective observational cohort study at a single vascular centre, analysing outcomes in non-elective CLTI patients over three different periods: one year prior to POPS ('Pre-POPS'); during the initial delivery when it was nurse-led ('POPS v1'); and after it became physician-led ('POPS v2'). The primary outcome was length of stay (LoS), with 30-day and 12-month secondary outcomes. Cohorts were compared using propensity-score weighted statistical analysis. Economic analysis was undertaken. Results Six hundred and two patients were included. LoS reduced sequentially with greater POPS input (17 days vs. 13 days vs. 11 days, P < .001). There was a significant reduction in 30-day acute kidney injury (33% vs. 37% vs. 8%, P < .001), myocardial infarction (15% vs. 2% vs. 2% P < .001) and hospital-acquired pneumonia (17% vs. 10% vs. 9%, P = .048). Cox survival regression found a reduction in 12-month mortality of 37% for the POPS v1 [HR 0.628 (95% CI 0.481–0.891) P = .013] and 40% for the POPS v2 [HR 0.598 (95% CI 0.431–0.913) P = .001] cohorts, respectively. Economic analysis found that handling more medically complex patients with a shorter LoS negated its operational costs. Conclusion A Vascular-POPS collaborative service has resulted in major improvements in LoS, adverse events and survival in this most vulnerable of vascular patient cohorts and is a financially sustainable initiative. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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