European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery · 2026
Clinical and Economic Impact of the Society for Vascular Surgery Wound, Ischaemia, and Foot Infection (WIfI) Classification: Insights from the Singapore Vascular Quality Initiative.
СтатьяНазвание и аннотация: Перевод в очереди
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Chia Adrian Choon Kwang, Zhao Yun, Tan Zi Ning, Yeo Wen Jing, Yap Charyl Jia Qi, Chen Stephanie Hui Min, Tan Ivan En-Howe, Ang Kwok Ann, Au Marianne Kit Har, Chong Tze Tec
Аннотация
OBJECTIVE: The Society for Vascular Surgery Wound, Ischemia, and Foot Infection (WIfI) classification is widely used for risk stratification in patients with chronic limb threatening ischaemia. However, its clinical and economic implications within an Asian healthcare setting remain unclear. This study aimed to examine the association between WIfI stages and hospital length of stay (LOS), inpatient costs, major amputation risk, and survival outcomes.
METHODS: This was a retrospective analysis of prospectively collected single centre data. Data were accrued from the Singapore General Hospital Vascular Quality Initiative registry and the hospital's central billing system. Data were analysed for 1 252 patients who underwent lower extremity peripheral vascular interventions between January 2019 and December 2024. WIfI stage (1 - 4) was determined at the time of intervention. Clinical outcomes included total and post-intervention LOS, complications, and major amputation and mortality rates. Total inpatient costs were assessed in 2024 US dollars. Multivariable linear regression and logistic regression were used to adjust for baseline covariables. Cox proportional hazards and Fine-Gray competing risks regression models evaluated overall survival (OS) and major amputation incidence, respectively.
RESULTS: Higher WIfI stages correlated significantly with longer mean total and post-intervention LOS, and higher inpatient hospitalisation costs ($25 547.7 in stage 1 vs. $51 520.2 in stage 4; p < .001). After multivariable adjustment, each WIfI stage increment was associated with an additional cost of $7 637 (95% confidence interval [CI] $5 733 - $9 541). Stage 4 patients had a significantly increased risk of major amputation (subdistribution hazard ratio 2.50, 95% CI 1.35 - 4.63) and reduced OS (hazard ratio 1.38, 95% CI 1.12 - 1.71).
CONCLUSION: The WIfI classification predicts clinical outcomes and hospitalisation costs in this Asian setting. Higher WIfI stages significantly increased hospital LOS, costs, major amputation risk, and mortality rate, emphasising the value of the classification for clinical and economic decision making.
METHODS: This was a retrospective analysis of prospectively collected single centre data. Data were accrued from the Singapore General Hospital Vascular Quality Initiative registry and the hospital's central billing system. Data were analysed for 1 252 patients who underwent lower extremity peripheral vascular interventions between January 2019 and December 2024. WIfI stage (1 - 4) was determined at the time of intervention. Clinical outcomes included total and post-intervention LOS, complications, and major amputation and mortality rates. Total inpatient costs were assessed in 2024 US dollars. Multivariable linear regression and logistic regression were used to adjust for baseline covariables. Cox proportional hazards and Fine-Gray competing risks regression models evaluated overall survival (OS) and major amputation incidence, respectively.
RESULTS: Higher WIfI stages correlated significantly with longer mean total and post-intervention LOS, and higher inpatient hospitalisation costs ($25 547.7 in stage 1 vs. $51 520.2 in stage 4; p < .001). After multivariable adjustment, each WIfI stage increment was associated with an additional cost of $7 637 (95% confidence interval [CI] $5 733 - $9 541). Stage 4 patients had a significantly increased risk of major amputation (subdistribution hazard ratio 2.50, 95% CI 1.35 - 4.63) and reduced OS (hazard ratio 1.38, 95% CI 1.12 - 1.71).
CONCLUSION: The WIfI classification predicts clinical outcomes and hospitalisation costs in this Asian setting. Higher WIfI stages significantly increased hospital LOS, costs, major amputation risk, and mortality rate, emphasising the value of the classification for clinical and economic decision making.