Todd R. Vogel, Gregory F. Petroski, Robin L. Kruse
Division of Vascular Surgery, University of Missouri Hospital & Clinics, Columbia, MO.
OBJECTIVES: The impact of interventions for critical limb ischemia (CLI) on functional status in the elderly remains unclear. Open (OPEN) and endovascular (ENDO) procedures were evaluated.
METHODS: Medicare inpatient claims were linked with nursing home assessment data to identify elective admissions for lower extremity procedures for CLI. A functional score (0-28; higher indicating greater impairment) based on activities of daily living, 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 pre-hospital function.
RESULTS: Four hundred fifty-two and 450 patients underwent OPEN and ENDO, respectively (rest pain (RP): 86; ulceration: 373; and gangrene: 443). Hospitalization was associated with a significant decline in function in both groups. Disease severity was associated with initial decline but not with the rate of recovery (p>0.35). OPEN had higher rates of recovery (p=0.011).
CONCLUSIONS: Open and endovascular procedures for CLI were associated with a similar initial decline in functional status suggesting less invasive endovascular procedures did not preserve baseline function. Endovascular procedures for CLI did not significantly improve functional status over time. Traditional open bypass significantly increased functional status for all CLI diagnoses with the greatest functional improvement being for ulceration. Further analysis is required to assist stakeholders in performing procedures most likely to improve functional status for CLI.
AUTHOR DISCLOSURES: R. L. Kruse
: Nothing to disclose; G. F. Petroski
: Nothing to disclose; T. R. Vogel
: Nothing to disclose.Posted April 2013