The risk of harm whilst waiting for varicose veins procedure

Abstract

Introduction

Varicose veins (VV) negatively impact quality of life (QoL) and have risks of major complications including bleeding, ulceration and phlebitis. During the COVID-19 pandemic, the VSGBI (Vascular Society of Great Britain and Ireland) and GIRFT (Get It Right First Time) classified VVs as lowest priority for intervention.

Objective

This study aims to determine harm caused and the impact on the QoL on patients waiting for their VVs procedures for more than 1 year.

Methods

This was a prospective study conducted at the Norfolk and Norwich University Hospital (NNUH). Patients with VVs awaiting intervention for >1 year were included in the study. Patients with CEAP C6 disease were considered to be too high risk to be invited for treatment during the Covid-19 pandemic. Patients were sent QoL questionnaires and underwent a telephone consultation to assess harm. Both generic (EQ-VAS and EQ-5D) and disease-specific (AVVQ and CIVIQ-14) instruments were utilised. There were no control groups available for comparison.

Results

275 patients were identified (37.1% male) with median time on waiting list of 60 weeks (IQR 56–65). 19 patients (6.9%) came to major harm, including phlebitis (3.6%), bleeding (1.8%) and ulceration (1.8%). Fifty-two patients (18.9%) had minor harm, including worsening pain (12.7%) and swelling (6.2%). 6.9% reported psychological harm. Rising CEAP stage was also associated with worsening level of harm in patients with C5-6 disease (p < 0.0001). Only 8.7% stated they would decline surgery during the pandemic. 104 QoL questionnaires were returned. Median EQ-VAS and EQ-5D was 75 (IQR: 60–85) and 0.685 (0.566–0.761), respectively. Median AVVQ score was 23.2 (14.9–31.0) and CIVIQ-14 score was 33 (21–44).

ConclusionsThis study highlights the impact of delaying VVs surgery during a pandemic. A significant rate of both major and minor as well as psychological harm was reported. In addition, VVs had a significant detriment to quality of life.

Keywords

varicose vein waiting list COVID-19 pandemic quality of life

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References

Evans

Fowkes

Ruckley

, et al. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiology Community Health 1999; 53: 149–153.

Bradbury

Evans

Allan

, et al. What are the symptoms of varicose veins? Edinburgh vein study cross sectional population survey. Br Medical Journal 1999; 318: 353–356.

Raetz

Wilson

Collins

. Varicose Veins: Diagnosis and Treatment. Am Fam Physician 2019; 99: 682–688.

Darvall

KAL

Bate

Adam

, et al. Generic Health-related Quality of Life is Significantly Worse in Varicose Vein Patients with Lower Limb Symptoms Independent of Ceap Clinical Grade. Eur J Vasc Endovascular Surg 2012; 44: 341–344. DOI: 10.1016/J.Ejvs.2012.06.022.

MacKenzie

Paisley

Allan

, et al. The effect of long saphenous vein stripping on quality of life. J Vascular Surgery 2002; 35: 1197–1203.

NICE Clinical Guideline Centre . Varicose veins in the legs - the diagnosis and management of varicose veins (Clinical guideline 168).

Davies

. The Seriousness of Chronic Venous Disease: A Review of Real-World Evidence. Adv Ther 2019; 36: 5–12. DOI: 10.1007/s12325-019-0881-7

COVIDSurg Collaborative . Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br Journal Surgery 2020; 107: 1440–1449. DOI: 10.1002/bjs.11746.

Stahel

. How to risk-stratify elective surgery during the COVID-19 pandemic? Patient Saf Surg 2020; 14. DOI: 10.1186/s13037-020-00235-9

10.

Ross

Lauer

Miles

, et al. Maximizing the Calm before the Storm: Tiered Surgical Response Plan for Novel Coronavirus (COVID-19). J Am Coll Surg 2020; 230: 1080–1091. DOI: 10.1016/j.jamcollsurg.2020.03.019.e1083

11.

Vascular Society of Great Britain & Ireland . Resumption of less urgent and elective (endo-) vascular surgery, 2020.

12.

COVID-19 response: Guidance on the resumption of less urgent/elective vascular and endovascular surgery.

13.

Cuschieri

. The STROBE guidelines. Saudi J Anaesth 2019; 13: S31–S34. DOI: 10.4103/sja.SJA_543_18

14.

Oudhoff

Timmermans

Knol

, et al. Waiting for elective general surgery: impact on health related quality of life and psychosocial consequences. BMC Public Health 2007; 7. DOI: 10.1186/1471-2458-7-164.

15.

Labropoulos

Leon

Kwon

, et al. Study of the venous reflux progression. J Vascular Surgery 2005; 41: 291–295. DOI: 10.1016/j.jvs.2004.11.014.

16.

Lee

Robertson

Boghossian

, et al. Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study. J Vasc Surg Venous Lymphat Disord 2015; 3: 18–26. DOI: 10.1016/j.jvsv.2014.09.008

17.

Vascular Society of Great Britain & Ireland . Provision of Services for People with Vascular Disease 2021, 2021.

18.

NHS England . Statistical Press Notice: NHS referral to treatment (RTT) waiting times data - November 2021, 2022.

19.

Vindegaard

Benros

. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun 2020; 89: 531–542. DOI: 10.1016/j.bbi.2020.05.048

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