Lower Extremity Revascularization Not Effective in Majority of Nursing Home Residents

UCSF News reports that U.S. only a small number of nursing home residents are alive and ambulatory one year after undergoing lower extremity revascularization procedures with those still alive gaining little, if any, function:

Only a few U.S. nursing home residents who undergo lower extremity revascularization procedures are alive and ambulatory a year after surgery, according to UCSF researchers, and most patients still alive gained little, if any, function.

The study appears in the April 6 issue of JAMA Internal Medicine.

“Our findings can inform conversations among physicians, patients and families about the risks and expected outcomes of surgery and whether the surgery is likely to allow patients to achieve their treatment goals,” said senior author Emily Finlayson, MD, MS, associate professor of surgery and geriatrics in the Philip R. Lee Institute for Health Policy Studies at UCSF. “Our findings also highlight the importance of carefully considering a prognosis independent of vascular disease and assessing the goals of care.”

Lower extremity peripheral arterial disease is common among nursing home residents, a substantial number of whom also are at risk for critical limb ischemia. Lower extremity revascularization through stents and other devices is frequently performed to preserve functional independence through limb preservation. However, these procedures have an operative risk, and their benefit in maintaining walking ability is debatable.

In addition to Dr. Finlayson, Director of the UCSF Center for Surgery in Older Adults, other members of the Department Surgery contributing to the JAMA study were Michael S. Conte, M.D., (left) Professor & Chief of the Division of Vascular & Endovascular Surgery, and Co-Director of UCSF Heart and Vascular Center  and UCSF Center for Limb Preservation; and Lawrence Oresanya, MD, (right) Chief Resident in the General Surgery Residency Program.