Abstract
We aimed to determine the correlation between the functional status at discharge in non-cardiac vascular surgery patients and the out-of-hospital mortality. We performed a retrospective cohort study including adult non-cardiac vascular surgery patients (open, endovascular and venous procedures) surviving hospitalization in Boston, Massachusetts, USA. The exposure of interest was functional status determined by a licensed physical therapist at hospital discharge and rated based on qualitative categories adapted from the Functional Independence Measure. The primary outcome was all cause 90-day mortality after hospital discharge. The secondary outcome was readmission within 30days. Adjusted odds ratios were estimated by multivariable logistic regression models. This cohort included 2318 patients (male 51%; mean age 61 ± 17.7). After evaluation by a physiotherapist, 425 patients scored the lowest functional status, 631 scored moderately low, 681 moderately high and 581 scored the highest functional status. The lowest functional status was associated with a 3.41-fold increased adjusted odds for 90-day mortality (95%CI, 1.70-6.84) compared to patients with the highest functional status. When excluding venous intervention patients, the adjusted odds ratio was 6.76 (95%CI, 2.53-18.12) for the 90-day mortality post-discharge. The adjusted odds for readmission within 30-days was 1.5-fold increase in patients with the lowest functional status (95%CI, 1.04-2.20). In vascular surgery patients surviving hospitalization, functional status is strongly associated with out-of-hospital mortality and readmission rate. Future trials could provide evidence if improvement of functional status could prevent adverse outcomes in the postoperative setting.
Highlights
The prevalence of peripheral artery disease increased between 2000 and 2010 to 13% with higher rates in older patients living in 462 von Meijenfeldt et al.Annals of Vascular Surgery high income countries[1]
As functional status might be an important risk factor contributing to out-of-hospital mortality, this study aimed at the association between functional status at hospital discharge and the out-of-hospital mortality in non-cardiac vascular surgery patients
Prospective data on all patients admitted to BWH between November 2004 and February 2012 were obtained through the Brigham Integrated Computing System[14] and the Research Patient Data Registry (RPDR)[15] and analysed retrospectively for this study
Summary
The prevalence of peripheral artery disease increased between 2000 and 2010 to 13% with higher rates in older patients living in 462 von Meijenfeldt et al.Annals of Vascular Surgery high income countries[1]. For aortic aneurysm patients who underwent endovascular surgery, an association between preoperative functional status and in-hospital outcomes has been established[9]. Long-term functional independence is the desirable outcome of treatment in most vascular surgery patients, as it is associated with a higher quality of life[11]. We aimed to determine the correlation between the functional status at discharge in non-cardiac vascular surgery patients and the out-of-hospital mortality. The lowest functional status was associated with a 3.41-fold increased adjusted odds for 90-day mortality (95%CI, 1.70– 6.84) compared to patients with the highest functional status. The adjusted odds for readmission within 30-days was 1.5-fold increase in patients with the lowest functional status (95%CI, 1.04–2.20). Conclusions: In vascular surgery patients surviving hospitalization, functional status is strongly associated with out-of-hospital mortality and readmission rate. Future trials could provide evidence if improvement of functional status could prevent adverse outcomes in the postoperative setting
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