Long-Term Functional Decline Following Vascular Surgery Among Vulnerable Adults

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Automated summary

The study found that the VES-13 survey can predict long-term functional decline in patients undergoing vascular surgery, with vulnerable patients more likely to experience declines in activities of daily living (ADLs) and instrumental activities of daily living (iADLs). This preoperative screening tool can help prepare older patients and caregivers for postoperative functional limitations.