Deepa P. Bhupali, MD


Dayama A, Pimple P, Badrinathan B, Lee R, and Reeves JG. Activities of Daily Living Is a Critical Factor in Predicting Outcome After Carotid Endarterectomy in Asymptomatic Patients. Stroke. 2014


Dayama et al. explore how functional status affects post-operative outcomes in patients undergoing carotid endarterectomy (CEA) for asymptomatic stenosis. They used a national dataset that included information from over 300 hospitals and looked at the effect of pre-operative functional status on post-operative outcomes including 30 day mortality following CEA in asymptomatic patients. Functional status was divided into independent, partially dependent and dependent. One of their primary findings was that patients who were partially or completely dependent for ADLs had a higher risk of 30 day mortality as compared to independent patients. 



Their paper is based on a procedure that is hotly debated in the stroke and vascular circles: CEA for asymptomatic stenosis. This means that the results of the study are specific to a procedure that is not universally accepted or practiced.  So while this is interesting information, there might be a narrow audience to receive it.
One of the strengths of the study is that it examined a population that is somewhat representative of the “real-world.” They used a group that likely represents many of the patients we see each day which makes the data more compelling. However, the overall conclusion, that a patient with a higher functional status does better in the post-operative period as compared to a more impaired level of functioning is not a new concept and may not immediately impact bedside care.