07 Apr Nursing Home Residents Unlikely To Gain Function From Leg Revascularization
MedicalResearch.com Interview with:
Emily Finlayson, MD, MS
Department of Surgery, Division of General Surgery
Department of Medicine, Division of Geriatrics
Philip R Lee Institute for Health Policy
University of California, San Francisco
Director, UCSF Center for Surgery in Older Adults
Medical Research: What is the background for this study? What are the main findings?
Dr. Finlayson: In general, the goal of lower extremity revascularization is to preserve the leg so that patients can maintain the ability to ambulate and maintain functional independence. We evaluated the results of this operation in older nursing home residents in the United States. We found that over the 3 year study period, over 10,000 nursing home residents underwent this procedure. Most of them were functionally dependent before surgery, 3/4 were unable to walk, and over half had dementia.
After 1 year, half of the residents had died. Among residents who could not walk before surgery, 89% were dead or non ambulatory 1 year after surgery.
Medical Research: What should clinicians and patients take away from your report?
Dr. Finlayson: Clinicians, patients, and their families should be aware that nursing home residents who undergo lower extremity revascularization are unlikely to gain functional benefit from this operation. Treatment options for patients with limited life expectancy and critical limb ischemia include nonoperative symptom control, local wound care, amputation, and lower extremity revascularization — each with their own risks and benefits. The approach to this disease in this vulnerable population should be individualized and take into account patient and family preferences and realistic information about what each therapy can achieve.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Finlayson: Clinical trials that compare the effectiveness of operative and nonoperative treatment of critical limb ischemia in patients with limited life expectancy would help inform clinical decision-making in this population.
Oresanya L, Zhao S, Gan S, et al. Functional Outcomes After Lower Extremity Revascularization in Nursing Home Residents: A National Cohort Study. JAMA Intern Med. Published online April 06, 2015. doi:10.1001/jamainternmed.2015.0486.
MedicalResearch.com Interview with: Emily Finlayson, MD, MS (2015). Nursing Home Residents Unlikely To Gain Function From Leg Revascularization