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Perioperative Optimization of Geriatric Lower Extremity Bypass in the Era of Increased Performance Accountability.

Publication ,  Journal Article
Adkar, SS; Turley, RS; Benrashid, E; Lagoo, S; Shortell, CK; Mureebe, L
Published in: Ann Vasc Surg
January 2017

BACKGROUND: The initiation of bundled payment for care improvement by Centers for Medicare and Medicaid Services (CMS) has led to increased financial and performance accountability. As most vascular surgery patients are elderly and reimbursed via CMS, improving their outcomes will be critical for durable financial stability. As a first step in forming a multidisciplinary pathway for the elderly vascular patients, we sought to identify modifiable perioperative variables in geriatric patients undergoing lower extremity bypass (LEB). METHODS: The 2011-2013 LEB-targeted American College of Surgeons National Surgical Quality Improvement Program database was used for this analysis (n = 5316). Patients were stratified by age <65 (n = 2171), 65-74 (n = 1858), 75-84 (n = 1190), and ≥85 (n = 394) years. Comparisons of patient- and procedure-related characteristics and 30-day postoperative outcomes stratified by age groups were performed with Pearson χ2 tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. RESULTS: During the study period, 5316 total patients were identified. There were 2171 patients aged <65 years, 1858 patients in the 65-74 years age group, 1190 patients in the 75-84 years age group, and 394 patients in the ≥85 years age group. Increasing age was associated with an increased frequency of cardiopulmonary disease (P < 0.001) and a decreased frequency of diabetes, tobacco use, and prior surgical intervention (P < 0.001). Only 79% and 68% of all patients were on antiplatelet and statin therapies, respectively. Critical limb ischemia occurred more frequently in older patients (P < 0.001). Length of hospital stay, transfusion requirements, and discharge to a skilled nursing facility increased with age (P < 0.001). Thirty-day amputation rates did not differ significantly with age (P = 0.12). CONCLUSIONS: Geriatric patients undergoing LEB have unique and potentially modifiable perioperative factors that may improve postoperative outcomes. These modifiers will be the basis of a multidisciplinary care path targeting the geriatric vascular surgery patients.

Duke Scholars

Published In

Ann Vasc Surg

DOI

EISSN

1615-5947

Publication Date

January 2017

Volume

38

Start / End Page

248 / 254

Location

Netherlands

Related Subject Headings

  • Vascular Surgical Procedures
  • United States
  • Treatment Outcome
  • Time Factors
  • Social Responsibility
  • Skilled Nursing Facilities
  • Risk Factors
  • Reoperation
  • Quality Indicators, Health Care
  • Quality Improvement
 

Citation

APA
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ICMJE
MLA
NLM
Adkar, S. S., Turley, R. S., Benrashid, E., Lagoo, S., Shortell, C. K., & Mureebe, L. (2017). Perioperative Optimization of Geriatric Lower Extremity Bypass in the Era of Increased Performance Accountability. Ann Vasc Surg, 38, 248–254. https://doi.org/10.1016/j.avsg.2016.05.111
Adkar, Shaunak S., Ryan S. Turley, Ehsan Benrashid, Sandhya Lagoo, Cynthia K. Shortell, and Leila Mureebe. “Perioperative Optimization of Geriatric Lower Extremity Bypass in the Era of Increased Performance Accountability.Ann Vasc Surg 38 (January 2017): 248–54. https://doi.org/10.1016/j.avsg.2016.05.111.
Adkar SS, Turley RS, Benrashid E, Lagoo S, Shortell CK, Mureebe L. Perioperative Optimization of Geriatric Lower Extremity Bypass in the Era of Increased Performance Accountability. Ann Vasc Surg. 2017 Jan;38:248–54.
Adkar, Shaunak S., et al. “Perioperative Optimization of Geriatric Lower Extremity Bypass in the Era of Increased Performance Accountability.Ann Vasc Surg, vol. 38, Jan. 2017, pp. 248–54. Pubmed, doi:10.1016/j.avsg.2016.05.111.
Adkar SS, Turley RS, Benrashid E, Lagoo S, Shortell CK, Mureebe L. Perioperative Optimization of Geriatric Lower Extremity Bypass in the Era of Increased Performance Accountability. Ann Vasc Surg. 2017 Jan;38:248–254.
Journal cover image

Published In

Ann Vasc Surg

DOI

EISSN

1615-5947

Publication Date

January 2017

Volume

38

Start / End Page

248 / 254

Location

Netherlands

Related Subject Headings

  • Vascular Surgical Procedures
  • United States
  • Treatment Outcome
  • Time Factors
  • Social Responsibility
  • Skilled Nursing Facilities
  • Risk Factors
  • Reoperation
  • Quality Indicators, Health Care
  • Quality Improvement