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Functional outcomes after lower extremity revascularization in nursing home residents: a national cohort study.
JAMA Intern Med. 2015 Jun; 175(6):951-7.JIM

Abstract

IMPORTANCE

Lower extremity revascularization often seeks to allow patients with peripheral arterial disease to maintain the ability to walk, a key aspect of functional independence. Surgical outcomes in patients with high levels of functional dependence are poorly understood.

OBJECTIVE

To determine functional status trajectories, changes in ambulatory status, and survival after lower extremity revascularization in nursing home residents.

DESIGN

Using full Medicare claims data for 2005 to 2009, we identified nursing home residents who underwent lower extremity revascularization. With the Minimum Data Set for Nursing Homes activities of daily living summary score, we examined changes in their ambulatory and functional status after surgery. We identified patient and surgery characteristics associated with a composite measure of clinical and functional failure-death or nonambulatory status 1 year after surgery.

SETTING

All nursing homes in the United States participating in Medicare or Medicaid.

PARTICIPANTS

Nursing home residents who underwent lower extremity revascularization.

MAIN OUTCOMES AND MEASURES

Functional status, ambulatory status, and death.

RESULTS

During the study period, 10,784 long-term nursing home residents underwent lower extremity revascularization. Prior to surgery, 75% of the residents were not walking; 40% had experienced functional decline. One year after surgery, 51% of patients had died, 28% were nonambulatory, and 32% had sustained functional decline. Among 1672 residents who were ambulatory before surgery, 63% had died or were nonambulatory at 1 year; among 7188 who were nonambulatory, 89% had died or were nonambulatory. After multivariate adjustment, factors independently associated with death or nonambulatory status were 80 years or older (adjusted hazard ratio [AHR], 1.28; 95% CI, 1.16-1.40), cognitive impairment (AHR, 1.23; 95% CI, 1.18-1.29), congestive heart failure (AHR, 1.16; 95% CI, 1.11-1.22), renal failure (AHR, 1.09; 95% CI, 1.04-1.14), emergent surgery (AHR, 1.29; 95% CI, 1.23-1.35), nonambulatory status before surgery (AHR, 1.88; 95% CI, 1.78-1.99), and decline in activities of daily living before surgery (AHR, 1.23; 95% CI, 1.18-1.28).

CONCLUSIONS AND RELEVANCE

Of nursing home residents in the United States who undergo lower extremity revascularization, few are alive and ambulatory 1 year after surgery. Most who were still alive had gained little, if any, function.

Links

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Authors+Show Affiliations

Oresanya L
Department of Surgery, University of California, San Francisco.
Zhao S
Department of Surgery, University of California, San Francisco.
Gan S
The Fielding School of Public Health, University of California, Los Angeles.
Fries BE
Institute of Gerontology and University of Michigan and VA Ann Arbor Healthcare Systems, Ann Arbor.
Goodney PP
Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire5The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire6The VA Outcomes Group, White River Junction, Vermont.
Covinsky KE
Division of Geriatrics, University of California, San Francisco8San Francisco Veterans Affairs Medical Center, San Francisco, California.
Conte MS
Department of Surgery, University of California, San Francisco.
Finlayson E
Department of Surgery, University of California, San Francisco7Division of Geriatrics, University of California, San Francisco9The Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco.

MeSH

AgedAged, 80 and overCohort StudiesFemaleHumansInpatientsLower ExtremityMaleRecovery of FunctionUnited StatesVascular GraftingWalking

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25844523

Citation

Oresanya, Lawrence, et al. "Functional Outcomes After Lower Extremity Revascularization in Nursing Home Residents: a National Cohort Study." JAMA Internal Medicine, vol. 175, no. 6, 2015, pp. 951-7.
Oresanya L, Zhao S, Gan S, et al. Functional outcomes after lower extremity revascularization in nursing home residents: a national cohort study. JAMA Intern Med. 2015;175(6):951-7.
Oresanya, L., Zhao, S., Gan, S., Fries, B. E., Goodney, P. P., Covinsky, K. E., Conte, M. S., & Finlayson, E. (2015). Functional outcomes after lower extremity revascularization in nursing home residents: a national cohort study. JAMA Internal Medicine, 175(6), 951-7. https://doi.org/10.1001/jamainternmed.2015.0486
Oresanya L, et al. Functional Outcomes After Lower Extremity Revascularization in Nursing Home Residents: a National Cohort Study. JAMA Intern Med. 2015;175(6):951-7. PubMed PMID: 25844523.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional outcomes after lower extremity revascularization in nursing home residents: a national cohort study. AU - Oresanya,Lawrence, AU - Zhao,Shoujun, AU - Gan,Siqi, AU - Fries,Brant E, AU - Goodney,Philip P, AU - Covinsky,Kenneth E, AU - Conte,Michael S, AU - Finlayson,Emily, PY - 2015/4/7/entrez PY - 2015/4/7/pubmed PY - 2015/8/13/medline SP - 951 EP - 7 JF - JAMA internal medicine JO - JAMA Intern Med VL - 175 IS - 6 N2 - IMPORTANCE: Lower extremity revascularization often seeks to allow patients with peripheral arterial disease to maintain the ability to walk, a key aspect of functional independence. Surgical outcomes in patients with high levels of functional dependence are poorly understood. OBJECTIVE: To determine functional status trajectories, changes in ambulatory status, and survival after lower extremity revascularization in nursing home residents. DESIGN: Using full Medicare claims data for 2005 to 2009, we identified nursing home residents who underwent lower extremity revascularization. With the Minimum Data Set for Nursing Homes activities of daily living summary score, we examined changes in their ambulatory and functional status after surgery. We identified patient and surgery characteristics associated with a composite measure of clinical and functional failure-death or nonambulatory status 1 year after surgery. SETTING: All nursing homes in the United States participating in Medicare or Medicaid. PARTICIPANTS: Nursing home residents who underwent lower extremity revascularization. MAIN OUTCOMES AND MEASURES: Functional status, ambulatory status, and death. RESULTS: During the study period, 10,784 long-term nursing home residents underwent lower extremity revascularization. Prior to surgery, 75% of the residents were not walking; 40% had experienced functional decline. One year after surgery, 51% of patients had died, 28% were nonambulatory, and 32% had sustained functional decline. Among 1672 residents who were ambulatory before surgery, 63% had died or were nonambulatory at 1 year; among 7188 who were nonambulatory, 89% had died or were nonambulatory. After multivariate adjustment, factors independently associated with death or nonambulatory status were 80 years or older (adjusted hazard ratio [AHR], 1.28; 95% CI, 1.16-1.40), cognitive impairment (AHR, 1.23; 95% CI, 1.18-1.29), congestive heart failure (AHR, 1.16; 95% CI, 1.11-1.22), renal failure (AHR, 1.09; 95% CI, 1.04-1.14), emergent surgery (AHR, 1.29; 95% CI, 1.23-1.35), nonambulatory status before surgery (AHR, 1.88; 95% CI, 1.78-1.99), and decline in activities of daily living before surgery (AHR, 1.23; 95% CI, 1.18-1.28). CONCLUSIONS AND RELEVANCE: Of nursing home residents in the United States who undergo lower extremity revascularization, few are alive and ambulatory 1 year after surgery. Most who were still alive had gained little, if any, function. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/25844523/Functional_outcomes_after_lower_extremity_revascularization_in_nursing_home_residents:_a_national_cohort_study_ DB - PRIME DP - Unbound Medicine ER -