Early Recognition of Venous Ulcer Improves Healing Rates and Resource Usage

Abstract

Venous insufficiency is often not readily recognized as a contributing etiology to nonhealing wounds by non–vascular surgery specialists, potentially delaying appropriate treatment to achieve wound healing and increasing health care costs. The objective of the present study was to understand the time and resources used before the definitive treatment of venous ulcers. A single-institution retrospective medical record review of patients with venous leg ulcers undergoing radiofrequency saphenous and perforator vein ablation from May 2016 to January 2018 identified 56 patients with 67 diseased limbs. The numbers of inpatient, emergency room, and wound care visits and the interval to vein ablation from the initial evaluation of the ulceration by a health care provider were collected. Demographics, comorbidities, wound characteristics, duplex imaging, and available wound healing follow-up through July 2018 were assessed for all patients. The 67 limbs examined had required 588 total health care visits for wound assessment before seeing a vascular surgeon, with 413 visits from a wound care center (70% of all visits; Table). Other specialty visits included emergency medicine (17.9% of limbs) and rheumatology (22.4% of limbs). Six patients (nine limbs) were admitted to inpatient services for their ulceration. Overall, patients were seen an average of 8.6 ± 9.7 times for their ulcer with the wound center before determination of the contributing venous etiology and subsequent treatment. These visits translated to a median of 230 days (first quartile, 86.5; third quartile, 1088 days) between the first identification of the ulcer by health care providers and subsequent accurate diagnosis and definitive treatment of their venous disease with radiofrequency saphenous and perforator vein ablation. After intervention, 18.64% of the limbs had healed at 1 month, 33.92% had healed at 3 months, 50% had healed at 6 months, and 82.92% had healed by 12 months (Fig). Educating health care providers on the accurate diagnosis of the venous contribution to ulcers and subsequent appropriate treatment of venous etiologies of wound formation can significantly improve healing and minimize resource usage.TableResource usage before radiofrequency saphenous and perforator vein ablationTotal no. of health care visits related to VLU before seeing a vein specialist588Limbs requiring debridement, n (%)19 (28.35)Total debridements, n85Average no. of debridements per limb4.4 ± 3.7Limbs requiring wound center visit, n (%)48 (71.6)Total wound care visits, n413Average no. of visits to wound center per limb8.6 ± 9.7VLU, Venous leg ulcer. Open table in a new tab