Leg Artery Surgery Among Nursing Home Residents May Be Overused: Study

Nursing home residents commonly undergo lower extremity revascularization surgery to help unblock clogged arteries in the legs, but new research suggests that the procedure may be overused and place elderly patients at risk of death or not being able to walk. 

In a study published this week in the medical journal JAMA Internal Medicine, researchers from the University of California, San Francisco (UCSF) indicate that leg artery surgery, often done on nursing home residents with peripheral arterial disease, rarely helps patients get back on their feet.

Lower extremity revascularization is used to reopen blocked or narrowed arteries caused by plaque buildup in the legs of frail nursing home residents who have peripheral arterial disease. The surgery is costly, requiring doctors to perform a bypass or insert a stent into the narrowed artery and is used to help patients maintain their ability to walk.

Researchers suggest that residents who undergo lower extremity revascularization may be at an increased risk of losing more physical function, ability to walk or of dying within a year of having the surgery.

The national cohort study lead by Dr. Emily Finlayson, director of UCSF Center for Surgery in Older Adults, analyzed Medicare claims data from 2005 to 2009 for nursing home residents who underwent the surgery. The study focused on changes in walking ability and functional status after surgery in nearly 11,000 long-term nursing home residents who were an average age of 82 years old.

Prior to surgery, three-quarters of patients were not walking and about 40 percent had experienced a decline in physical function. One year following the surgery, half of the patients had died. About 28 percent who could walk before surgery could not walk afterward and 32 percent of all patients had a decline in physical function.

“Of nursing home residents in the United States who undergo lower extremity revascularization, few are alive and ambulatory one year after surgery,” said Finlayson. “Most who were still alive had gained little, if any, function.”

Among the 1,700 patients who were able to walk before the surgery, one year following their surgery 63 percent had died. Among the more than 7,000 patients who were not able to walk prior to surgery, one year after surgery 89 percent had either died or remained non-ambulatory.

Peripheral arterial disease is common among nursing home residents and can cause extreme and chronic pain, often promoting infections or gangrene that can lead to amputation.

Despite the unfavorable outcomes, researchers aren’t entirely onboard with dismissing the surgery as ineffective. They say any type of surgery may be hard on an elderly and frail patient.

The surgery often helps patients hoping to stay mobile, maintain their ability to walk, even if only for a few months to a year, before dying. It can also help to lessen or alleviate pain, even when patients remain unable to walk.

The majority of patients who underwent the lower extremity revascularization suffered other health issues before surgery, including mental impairment, congestive heart failure and kidney failure.

However, they do admit, most patients who undergo the surgery are unlikely to gain functional benefit from the operation and never get back to their baseline function.