Key result
Complex endovascular aortic repair significantly increased health disability at one month postoperatively compared to baseline (median WHODAS 2.0 score 31.5 vs 13.6, p=0.017), with most patients recovering by six months.
Why the study?
Complex endovascular aortic repair carries high complication risks and substantial stress, but knowledge regarding its potentially long-lasting physical and mental effects and who is most at risk was limited.
Cohort (n=25)
No
Absolute Event Rate: 31.5% vs 13.6%
p-value: p=0.017
Complex endovascular aortic repair causes a temporary increase in health disability at one month, but most patients recover by six months without significant long-term negative effects on quality of life or mental health.
Supports targeted nursing follow-up for incomplete recovery after complex EVAR; leaves open which patient factors predict persistent impairment.
RATIONALE: Complex endovascular aortic repair often involves multiple major procedures over time with a high risk of complications and little time for recovery. This exposes patients to great stress, both physically and mentally, with potentially long-lasting effects. There is limited knowledge about these effects and who is most at risk - information on this could help vascular nurses and other healthcare professionals anticipate and meet care needs. AIM: To investigate the health and quality of life effects of complex endovascular aortic repair, in relation to patients' demographic and health characteristics. DESIGN: A prospective cohort study. METHODS: Patients undergoing elective complex endovascular aortic repair were consecutively recruited from one university hospital during one year (n=25). Self-report questionnaires on health disability (WHODAS 2.0), quality of life (WHOQoL-BREF) and symptoms of anxiety and depression (HADS) were filled out preoperatively and repeated one and six months postoperatively. Prospective changes in health and quality of life, and associations with patient demographics and preoperative health characteristics, were assessed. Ethical approval was obtained prior to study performance. RESULTS: Overall, patients had significantly greater health disability at one month (WHODAS 2.0 score median 31.5, range 1.1-63.0) than preoperatively (median 13.6, range 0.0-41.3) (n=22, p=.017); the majority had recovered at six months (median 11.4, range 3.3-58.7) (n=18, p=.042). No significant effects were seen in quality of life and symptoms of anxiety and depression (p>.05). However, the participants showed heterogeneity, with certain individuals not recovered at six months (n=8). Factors associated with worse six-month outcomes were being female, age < 70 years, postoperative complications, and history of anxiety or depression. CONCLUSIONS: Complex endovascular aortic repair have limited long-term negative effects on patients' health and quality of life. However, some patients are not recovered at six months postoperatively, which could be explained by individual characteristics. To improve recovery outcomes, vascular nurses and other health care professionals should be aware of the possible recovery trajectories and factors associated with impaired recovery, and use them to anticipate and meet the patients' individual care needs.
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Haakseth et al. (2023) conducted a cohort in Aortic aneurysms or type B dissections requiring complex endovascular aortic repair (n=25). Complex endovascular aortic repair (EVAR) vs. Preoperative baseline was evaluated on Health disability (WHODAS 2.0 summary score) at 1 month postoperatively (p=0.017). Complex endovascular aortic repair significantly increased health disability at one month postoperatively compared to baseline (median WHODAS 2.0 score 31.5 vs 13.6, p=0.017), with most patients recovering by six months.
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