Assessment of Quality of Life after Endovascular and Open Abdominal Aortic Aneurysm Repair: A Retrospective Single-Center Study

Q: What are the key findings of this study?

Endovascular and open abdominal aortic aneurysm repair showed comparable long-term quality of life across 7 of 8 SF-36 domains, while incisional hernia after open repair reduced physical and emotional role functioning.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Abdominal aortic aneurysm (n=83). Intervention: Endovascular aortic repair (EVAR) vs. Open repair (OR). Primary outcome: Health-related quality of life (HRQoL) assessed by the SF-36 Mental Health (MH) domain (p=<0.05).

Q: What does this research mean for the field?

Long-term health-related quality of life does not significantly differ between open repair and endovascular aneurysm repair, but the occurrence of incisional hernia after open repair significantly impairs physical and emotional functioning. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To compare long-term health-related quality of life in patients undergoing open repair or endovascular aneurysm repair for abdominal aortic aneurysms and evaluate the impact of incisional hernia formation.

Johanna Gruel; Eberhard Grambow; Malte Weinrich; Thomas Heller; Justus Groß; Matthias Leuchter; Mark Philipp

doi:10.3390/jcm11113017

May 27, 2022Journal of Clinical MedicineOpen Access

Assessment of Quality of Life after Endovascular and Open Abdominal Aortic Aneurysm Repair: A Retrospective Single-Center Study

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Key result

EVAR and open AAA repair show comparable long-term quality of life across most domains.

P<0.05
n=83

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Why the study?

Postoperative quality of life is an important outcome parameter after abdominal aortic aneurysm treatment, prompting comparison of health-related quality of life between open repair and endovascular treatment, and assessment of incisional hernia effects.

Does endovascular aortic repair (EVAR) improve long-term health-related quality of life compared to open repair (OR) in patients with abdominal aortic aneurysm, and how does incisional hernia formation after OR affect quality of life?

Key Points

To compare long-term health-related quality of life in patients undergoing open repair or endovascular aneurysm repair for abdominal aortic aneurysms and evaluate the impact of incisional hernia formation.
Retrospective single-center study assessing 83 patients (open repair: n = 36; endovascular repair: n = 47) treated for abdominal aortic aneurysm between 2008 and 2016 at a University Medical Center.
Health-related quality of life was evaluated with the SF-36 questionnaire across a mean follow-up of 7.1 years (range: 3.6 to 12.4 years).
Incisional hernia occurrence was determined from patient records and structured telephone interviews.
Neither surgical technique demonstrated an overall quality-of-life advantage: open repair scored significantly higher only in mental health (62 [60–64] vs 60 [60–60], p < 0.05), with no significant differences across the other seven domains.
Incisional hernia occurred in 30.6% (n = 11) of open repair patients.
Patients with postoperative incisional hernia exhibited significantly reduced scores in physical functioning (65 [40–65] vs 70 [45–90], p < 0.05), role physical (25 [0–100] vs 100 [25–100], p < 0.05), and role emotional (100 [100–100] vs 100 [100–100], p < 0.05).

Study Design

Type

Cohort (n=83)

Multicenter

No

Structured PICO

Does endovascular aortic repair (EVAR) improve long-term health-related quality of life compared to open repair (OR) in patients with abdominal aortic aneurysm, and how does incisional hernia formation after OR affect quality of life?

P

Population

83 patients with abdominal aortic aneurysm treated with open repair (n=36, mean age 64.0 years) or endovascular aortic repair (n=47, mean age 70.2 years) at a German University Medical Center, followed for a mean of 7.1 years.

E

Exposure

Endovascular aortic repair (EVAR, n=47) performed under general anesthesia with open surgical groin access using Excluder (20/47), Endurant II (21/47), Zenith Flex (5/47), or Ovation (1/47) endograft systems.

C

Comparator

Open surgical repair (OR, n=36) via median laparotomy (72.2%), retroperitoneal access (16.7%), or initial laparoscopy (11.1%), with standardized continuous fascia closure using two running CT-1 PDS loop sutures in small bites technique without primary prophylactic mesh.

O

Outcome

Health-related quality of life (HRQoL) across 8 domains of the 36-item short-form health survey (SF-36) at a mean follow-up of 7.1 years (range 3.6 to 12.4 years), and the impact of postoperative incisional hernia (IH) on HRQoL.patient reported

Main Result

Absolute Event Rate: 60% vs 62%

p-value: p=<0.05

Limitations

Retrospective single-center design with varying follow-up times between treatment and SF-36 assessment (3.6 to 12.4 years)
High exclusion rate (175 of 258 initially identified patients excluded due to missing contact data, death, or refusal)
Lack of baseline preoperative SF-36 survey data to assess changes in HRQoL from before treatment
Incomplete clinical follow-up attendance (63.9% after OR) and reliance on patient phone self-report for incisional hernia detection
Retrospective single-center study design
Variable time span between initial treatment and SF-36 assessment among patients (3.6 to 12.4 years)
No baseline preoperative SF-36 survey available
High attrition/exclusion rate (175 of 258 patients excluded)
Potential underreporting of incisional hernia due to 63.9% clinical follow-up attendance and reliance on telephone self-reporting

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Implication

Long-term health-related quality of life is comparable between open and endovascular AAA repair, but incisional hernia occurs in nearly one-third of open repair patients and significantly impairs physical and emotional functioning.

Abstract

Postoperative quality of life is an important outcome parameter after treatment of abdominal aortic aneurysms. The aim of this retrospective single-center study was to assess and compare the health-related quality of life (HRQoL) of patients after open repair (OR) or endovascular treatment (EVAR), and furthermore to investigate the effect of incisional hernia (IH) formation on HRQoL. Patients who underwent OR or EVAR for treatment of an abdominal aortic aneurysm between 2008 and 2016 at a University Medical Center were included. HRQoL was assessed using the SF-36 questionnaire. The incidence of IH was recorded from patient files and by telephone contact. SF-36 scores of 83 patients (OR: n = 36; EVAR: n = 47) were obtained. The mean follow-up period was 7.1 years. When comparing HRQoL between OR and EVAR, patients in both groups scored higher in one of the eight categories of the SF36 questionnaires. The incidence of IH after OR was 30.6%. In patients with postoperative IH, HRQoL was significantly reduced in the dimensions “physical functioning”, “role physical” and “role emotional” of the SF-36. Based on this data, it can be concluded that neither OR nor EVAR supply a significant advantage regarding HRQoL. In contrast, the occurrence of IH has a relevant impact on the HRQoL of patients after OR.

Discussion

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Cite This Study

Gruel et al. (2022) conducted a cohort in Abdominal aortic aneurysm (n=83). Endovascular aortic repair (EVAR) vs. Open repair (OR) was evaluated on Health-related quality of life (HRQoL) assessed by the SF-36 Mental Health (MH) domain (p=<0.05). Endovascular and open abdominal aortic aneurysm repair showed comparable long-term quality of life across 7 of 8 SF-36 domains, while incisional hernia after open repair reduced physical and emotional role functioning.

synapsesocial.com/papers/6a75c52f9c92392688b25000 https://doi.org/10.3390/jcm11113017

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Assessment of Quality of Life after Endovascular and Open Abdominal Aortic Aneurysm Repair: A Retrospective Single-Center Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Assessment of Quality of Life after Endovascular and Open Abdominal Aortic Aneurysm Repair: A Retrospective Single-Center Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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