Long-Term Functional Decline Following Vascular Surgery Among Vulnerable Adults

• Published in: Annals of vascular surgery Vol. 76; pp. 87 - 94
• Main Authors: DeAngelo, Madeline M., Peacock, Jordan B., Holeman, Teryn A., Maloney, Maria, Beckstrom, Julie, Brooke, Benjamin S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.10.2021
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Clinical Decision-Making; Decision Support Techniques; Disability Evaluation; Female; Functional Status; Geriatric Assessment; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Risk Assessment; Risk Factors; Self Report; Time Factors; Treatment Outcome; Vascular Diseases - surgery; Vascular Surgical Procedures - adverse effects; Vulnerable Populations
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2021.04.002

Identification of high-risk patients that may experience functional decline following surgery poses a challenge to healthcare providers. The Vulnerable Elders Survey (VES-13) is a patient-reported tool designed to identify risk for health deterioration based on age, self-rated health, physical function, and functional disabilities. This study was designed to determine whether VES-13 could predict long-term functional decline among patients undergoing vascular surgery procedures. Vascular surgery patients at an academic hospital were administered VES-13 between May 2018 and March 2019, and those scoring ≥3-points were classified as vulnerable. Each patient's functional status was assessed using the Katz Activities of Daily Living (ADL) and the Lawton-Brody Instrumental Activities of Daily Living (iADL) indices preoperatively and at 2-week, 1-month, and 1-year postoperative time points. Logistic regression models were used to identify independent predictors of functional decline. 126 patients (59% male) were assessed before and after minor (56%) and major (44%) vascular procedures, with 55 (43%) meeting criteria for vulnerability. Vulnerable patients were older, had lower baseline functional status, and were more likely than non-vulnerable patients to experience declines in ADLs and iADLs at all time-points (P < 0.05 for all time points). These findings were confirmed in risk-adjusted regression models where vulnerability was associated with an increased likelihood of decline in ADLs (OR:3.3; 95%CI:1.0-10.6; P < 0.05) and iADLs (OR:2.6; 95%CI:1.0-6.6; P = 0.05) at 1-year following surgery. The patient-reported VES-13 survey identifies vulnerable patients who are at risk for long-term functional decline following vascular surgery. This quick preoperative screening tool can allow surgeons to prepare older patients and caretakers for postoperative functional limitations.