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Functional status of elderly adults before and after interventions for critical limb ischemia.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2014 Feb; Vol. 59 (2), pp. 350-8. Date of Electronic Publication: 2013 Oct 16. - Publication Year :
- 2014
-
Abstract
- Objective: The impact of interventions for critical limb ischemia (CLI) on functional status in the elderly remains unclear. Open and endovascular procedures were evaluated.<br />Methods: Medicare inpatient claims were linked with nursing home assessment data to identify elective admissions for lower extremity procedures for CLI. A functional impairment score (0-28; higher scores indicating greater impairment) based on residents' need for assistance with self-care activities, walking, and locomotion was calculated before and after interventions. Hierarchical modeling determined the effect of the surgery on residents' function, controlling for comorbidity, cognition, and prehospital function.<br />Results: Three hundred fifty-two and 350 patients underwent open and endovascular procedures, respectively (rest pain, 84; ulceration, 351; gangrene, 267). Hospitalization was associated with a significant worsening in function following both procedures. Disease severity was associated with the amount of initial decline but not with the rate of recovery (P > .35). Residents who received open surgery improved more quickly following hospital discharge (P = .011).<br />Conclusions: In the frail elderly, open and endovascular procedures for CLI were associated with similar initial declines in functional status, suggesting that compared with open procedures, less invasive endovascular procedures were not associated with maintaining baseline function. In this select population, endovascular procedures for CLI were not associated with improved functional status over time compared with open. Six months posthospital, patients who received traditional open bypass had significantly better functional status than those who received endovascular procedures for all CLI diagnoses. Further analysis is required to assist stakeholders in performing procedures most likely to preserve functional status in the frail elderly and nursing home population.<br /> (Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Subjects :
- Activities of Daily Living
Age Factors
Aged
Aged, 80 and over
Chi-Square Distribution
Cognition
Comorbidity
Critical Illness
Elective Surgical Procedures
Female
Frail Elderly
Homes for the Aged
Hospitalization
Humans
Ischemia physiopathology
Ischemia psychology
Linear Models
Logistic Models
Male
Medicare
Nursing Homes
Odds Ratio
Predictive Value of Tests
Propensity Score
Recovery of Function
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
United States
Walking
Endovascular Procedures adverse effects
Geriatric Assessment
Ischemia diagnosis
Ischemia surgery
Lower Extremity blood supply
Vascular Surgical Procedures adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 59
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 24139567
- Full Text :
- https://doi.org/10.1016/j.jvs.2013.08.087