Age Ageing. 2026 Jan 3;55(1):afag003. doi: 10.1093/ageing/afag003.
ABSTRACT
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.
PMID:41609321 | DOI:10.1093/ageing/afag003