Insights From the NHS England Hospital Episode Statistics on Hospital Admissions for Patients With Chronic Limb Ischemia in Superficial Femoral and Popliteal Arteries

OBJECTIVES: Chronic limb ischemia (CLI) is the most severe stage of peripheral arterial disease and is characterized by chronic pain at rest, tissue loss, and a high risk of amputation and death. CLI is a major burden for patients and healthcare systems, requiring costly interventions to restore blood flow and prevent limb loss.

This study aimed to provide an overview of inpatient characteristics and the cost of treating patients with CLI in the superficial femoral and popliteal arteries (SFA/PA).

METHODS: Patients diagnosed with CLI between April 2022 and March 2023 were identified from the Hospital Episode Statistics (HES) dataset based on specific diagnosis (ICD) and procedure (OPSC) codes. Age, gender, treatment cost, type of admission, and return to care were analyzed.

RESULTS: The study identified 7,325 CLI patients who had undergone revascularization of the SFA/PA. Most were men (67%) over 65 years old (73%), of whom 36% had tissue loss. Overall, 64% of admissions were elective and 36% non-elective. The total cost of the hospital stays was £50.7 million, of which £33.9 million was spent on non-elective procedures (64% of the total costs). The average cost per patient was £6,925 (£3,339 elective, £12,158 non-elective). Return-to-care rates ranged from 3% (14 days) to 14% (90 days). The 30-day emergency re-admission rate was 7%.

In the subgroup with tissue loss, the total cost was £22.5 million. The rate of non-elective admissions was higher at 50%. The average cost per patient was higher, at £8,532.

CONCLUSIONS: This study provides an overview of the CLI inpatient characteristics using real-world evidence from HES. The results show that CLI is a costly condition, with a high proportion of patients presenting with tissue loss and requiring non-elective admissions. These findings can inform future research and decision-making on the optimal management of CLI patients in NHS England.