Functional status of nursing home residents before and after abdominal aortic aneurysm repair

Although many trials have evaluated abdominal aortic aneurysm (AAA) repair, the impact of these procedures on the functional status of frail elderly patients is not well-described. The effects of elective open AAA repair (OAR) and endovascular AAA repair (EVAR) and comorbidities were evaluated for their impact on functional trajectories after discharge. Medicare inpatient claims were linked with nursing home assessment data to identify elective admissions for OAR and EVAR. A functional score (range, 0-28; higher scores indicate greater impairment) was calculated before and after interventions. Logistic regression was used to develop a propensity score for receiving EVAR because residents were not randomized. Hierarchical linear modeling determined the effect of surgery on residents' function, controlling for prehospital function, hospital length of stay (LOS), stroke, and the propensity score.Fifty-two residents underwent OAR and 161 underwent EVAR. Most (65.3%) were men and 62.0% were from 76 to 85 years old. Mean LOS was 8.3 days for OAR and 5.1 days for EVAR. Of the residents, 47.4% had good prehospital function (activities of daily living [ADL] score of 0-10), and 48.4% were moderately impaired (ADL score of 11-20). Higher baseline ADL score, increased LOS, and stroke were associated with worse trajectories. Procedure type was not significantly related to postoperative function or the subsequent rate of improvement. OAR and EVAR were associated with similar initial declines and comparable postoperative trajectories, suggesting that less invasive EVAR was not associated with improved functional preservation compared with OAR. LOS was found to be higher than expected in the frail elderly after EVAR; longer stays were associated with poorer functional trajectories. Higher baseline ADL scores were significantly associated with inferior functional status after both procedures. Evaluation of preoperative function may assist physicians in predicting outcomes in this high-risk population.