title: Functional outcomes after lower extremity revascularization in nursing home residents: a national cohort study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  All nursing homes in the United States participating in Medicare or Medicaid.
  
  
  METHODS
  Nursing home residents who underwent lower extremity revascularization.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Surgery, University of California, San Francisco.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Oresanya
authors.affiliation: Department of Surgery, University of California, San Francisco.
authors.forename: Shoujun
authors.initials: S
authors.lastname: Zhao
authors.affiliation: The Fielding School of Public Health, University of California, Los Angeles.
authors.forename: Siqi
authors.initials: S
authors.lastname: Gan
authors.affiliation: Institute of Gerontology and University of Michigan and VA Ann Arbor Healthcare Systems, Ann Arbor.
authors.forename: Brant E
authors.initials: BE
authors.lastname: Fries
authors.affiliation: 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.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.affiliation: Division of Geriatrics, University of California, San Francisco8San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Covinsky
authors.affiliation: Department of Surgery, University of California, San Francisco.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Conte
authors.affiliation: 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.
authors.forename: Emily
authors.initials: E
authors.lastname: Finlayson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D020127:Recovery of Function; D014481:United States / Q000453:epidemiology; D058017:Vascular Grafting / Q000401:mortality*; D016138:Walking / Q000706:statistics & numerical data*
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