title: Functional status of elderly adults before and after interventions for critical limb ischemia.
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.
  
  
  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.
  
  
  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).
  
  
  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.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, Mo. Electronic address: vogeltr@health.missouri.edu.
authors.forename: Todd R
authors.initials: TR
authors.lastname: Vogel
authors.affiliation: Department of Health Management and Informatics, University of Missouri, School of Medicine, Columbia, Mo.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Petroski
authors.affiliation: Department of Family and Community Medicine, University of Missouri, School of Medicine, Columbia, Mo.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Kruse
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003071:Cognition; D015897:Comorbidity; D016638:Critical Illness; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D016014:Linear Models; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D006278:Medicare; D009735:Nursing Homes; D016017:Odds Ratio; D011237:Predictive Value of Tests; D057216:Propensity Score; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D016138:Walking