VESS03 - Integration of Palliative Care Consultation into the Management of Patients with Chronic Limb Threatening Ischemia: A Pilot Study

Objectives: We assessed the feasibility of integrating palliative care consultation into management of patients with chronic limb threatening ischemia (CLTI).

Methods: This was a single institution, prospective, observational study supported by the Society of Vascular Surgery Vascular Quality Initiative which looked at the impact of palliative care consultation for patients with CLTI. A health-related quality of life questionnaire comprised of Vascu-Qol-6 and a modified palliative care survey was administered before and after palliative consultation to patients admitted to the vascular service for ≥48 hours. Length of stay and mortality was compared between our study group and a historically matched cohort of patients with CLTI.

Results: Over a 14-month enrollment period, 44% of patients (N=39) with CLTI (rest pain=36%, tissue loss=64%) admitted to the vascular service received palliative care consultation, compared with 5% of patients who would have met criteria over the preceding 14 months before our protocol was instituted. The mean age was 69, 23% were female, 97% white and 49% were independently ambulatory (Table I). Revascularization included bypass (46%), peripheral vascular intervention (23%), and femoral endarterectomy (21%). 26% underwent minor amputation or wound debridement, 15% underwent major amputation, and no patients received medical management alone. The mean Vascu-Qol-6 on admission was 10.4 (SD 4.2). After receiving palliative care consultation, patients reported experiencing less emotional distress than before consultation (2.1 vs 2.7, p=0.03). They also reported being less bothered by uncertainty regarding what to expect from the course of their illness (2.5 vs 3.4, p=0.002). Fewer patients reported being unsure of the purpose of their medical care after palliative care consultation (8%) vs before (18%) although this was not statistically significant (p=0.10). Median length of stay was longer in the study group compared with the historic cohort (8 vs. 7 days, p=0.02). There was no difference in 30-day mortality (3 vs. 8%, p=0.42) between the study group and the historic cohort (N=77).

Conclusions: Integrating inpatient palliative care consultation into the routine management of patients with CLTI is feasible and beneficial. Patients reported improved emotional domains of health related quality of life. This study laid the foundation for a future randomized controlled trial to further assess the impact of palliative care as part of the routine management for this challenging patient population.