Functional Status Measured at Hospital Discharge is Strongly Associated With Out-of-hospital Mortality and Re-admission in Non-cardiac Vascular Surgery Patients Surviving Admission

Abstract

Introduction: Evaluation of the functional dependency of vascular surgery patients has proved to correlate with short-term mortality but lacks data in the long-term. The aim of this study was to determine the correlation between the functional status at discharge and the out-of-hospital mortality. Methods: We performed an observational cohort study including non-cardiac vascular surgery patients (open and endovascular) surviving hospital admission of 18 years or older in a tertiary care medical center. The exposure of interest was functional status determined by a licensed 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. Adjusted odds ratios were estimated by multivariable logistic regression models. Results: 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 patients moderately high and 581 patients scored the highest functional status. The unadjusted association of lowest functional status with 90-day mortality showed a 6.04-fold increase of odds (95% confidence interval(CI), 3.16-11.52) compared to patients with the highest functional status. After adjustement for age, gender, race, Deyo-Charlson index, patient type (surgical vs. medical), length of stay and vascular surgery type the association of lowest functional status with 90-day mortality was increased 3.41-fold (95% confidence interval(CI), 1.70-6.84) compared to patients with the highest functional status. When excluding patients who underwent venous interventions the adjusted odds ratio was 6.76 (95%CI, 2.53-18.12) for the 90-day mortality post-discharge. The odds for re-admission within 30-days was 1.5 fold increased in patients who scored the lowest functional status. Conclusion: In vascular surgery patients surviving admission, functional status is strongly associated with out-of-hospital mortality and readmission rate. This is especially apparent in patient who underwent an arterial vascular procedure. Ultimately, functional status could become a prevention target to improve the post-operative survival of vascular surgery patients by optimizing the functional status in the preoperative and postoperative setting. Disclosure: Nothing to disclose