Southern Association for Vascular Surgery
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Functional Status in Non-home Discharges After Vascular Surgery
Andrew Mitchell, Zdenek Novak, Xiaofei Qiao, Emily Spangler
University of Alabama at Birmingham Heersink School of Medicine, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL

INTRODUCTION: Non-home discharges (NHD) from hospitalizations are frequent in vascular surgery patients due to a high prevalence of frailty and comorbidities. Current surgical risk calculators help predict risk of NHD, but not length of facility stay or impact on functional abilities. Medicare requires Inpatient Rehabilitation Facilities (IRFs) to collect and submit a standardized comprehensive assessment of patients' abilities, the IRF Patient Assessment Instrument (IRF-PAI). This pilot seeks to show feasibility in linking IRF-PAI metrics with vascular surgery quality database patient data to more completely describe functional recovery in patients with NHD after vascular surgery.
METHODS: The Society for Vascular Surgery Vascular Quality Initiative (VQI) is a national vascular quality registry. This retrospective study identified 128 patients at our tertiary medical center who underwent VQI procedures and had a VQI-reported NHD disposition from 2016-2022. Of these, 59 patients were identified in our academic medical centerís rehabilitation facility Medicare IRF-PAI reporting. Patient-level linkage of VQI data to IRF-PAI metrics allowed for characterization of NHD length of stay and functional status using descriptive statistics and paired comparisons between admission and discharge. Functional status was evaluated over two main domains: self-care and mobility. Self-care tasks included eating, oral hygiene, toileting, showering, upper body dressing, lower body dressing, and footwear donning/removal. Mobility tasks included roll left and right, sitting to lying, lying to sitting, sit to stand, chair/bed to chair transfer, and toilet transfer. Patients were scored from 1 to 6 on a scale of increasing independence for each task, and summative scores were created for both domains.
RESULTS: Our cohort had a median age of 60[49-70]; 61% were male, 52% white, and 46% African American. The procedures included 19 carotid artery interventions, 18 endovascular aneurysm repairs, and 22 peripheral bypasses. The median rehab length of stay for the cohort was 12 days [8-17]. Self-care summative scores were similar across all procedures on admission (25.5[22-29.25]), and there was a significant improvement in scores for the cohort by discharge (33[25-38], p < .01). Admission mobility summative scores in aneurysm repair or lower extremity bypass patients (19[14-24]) were lower than carotid artery intervention patients (24[19-26]), but across all procedures significant improvements and similar scores were seen by discharge (30[22.5-34], p < .01).
CONCLUSIONS: This pilot shows feasibility in linking IRF-PAI functional data with VQI institutional data. Our VQI patients discharging to rehabilitation facilities can expect a nearly two-week stay and functional gains in self-care and mobility. Future studies will be directed toward the linkage of national IRF-PAI Medicare files and VQI-linked Medicare data to expand understanding of patient recovery after vascular surgery.


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