Vascular-POPS: evidence for a new standard of care in the management of chronic limb-threatening Ischaemia.

Khan, A.; Davies, H.; Fawcett, LE.; Darwood, R.; Anthony, R.; Wallace, T.

Vascular-POPS: evidence for a new standard of care in the management of chronic limb-threatening Ischaemia.

All Authors

Khan, A.

Davies, H.

Fawcett, LE.

Darwood, R.

Anthony, R.

Wallace, T.

LTHT Author

Khan, Assad
Davies, Henry
Fawcett, Lee-Ellen
Darwood, Rosemary
Anthony, Rebecca
Wallace, Tom

LTHT Department

Trauma & Related Services
Vascular Surgery
Leeds Vascular Institute
Specialty & Integrated Medicine
Elderly Care Medicine

Publication Date

2026

Item Type

Journal Article
Observational Study

Subject

ISCHAEMIA , STANDARD OF CARE , HOSPITALS , FRAILTY , SURVIVAL

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. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com.