Health Related Quality of Life after Treatment of Abdominal Aortic Aneurysm with Open and Endovascular Techniques—A Two-Year Follow Up

Abstract

Background: Patients with Abdominal Aortic Aneurysm can be treated with two different surgical methods: Open Repair (OR) or Endovascular Aortic Repair (EVAR). These two different treatments can probably result in different sense of Health Related Quality of Life, both in a short term and a long term perspective. The purpose of this prospective study was to examine patients' Health Related Quality of Life after surgical treatment of Abdominal Aortic Aneurysm over two years using different instruments for the observations. Methods: Patients were invited consecutively to answer questionnaires before operation, and 1, 12 and 24 months after surgery. The study was conducted by using the Health Related Quality of Life questionnaires Short Form (SF-36) and Nottingham Health Profile (NHP). 76 patient (40 in the OR and 36 in the EVAR group) participated in the study. The mean age in the OR group were 68 years, range 52 -80 and in the EVAR group 75 years, range 65 -85. The results from these two groups of patients were compared to a matched reference group. Results: Both patients treated with EVAR and OR rated their Health Related Quality of Life significantly lower in the domain of Mental Health in relation to a matched reference population before surgery. This difference was not present two years after intervention. After one month Health related qualities of life were worse for the OR group. After two years significant improvements in relation to baseline were observed only among patients in the OR group. No such long-term benefits were seen in the EVAR group. Conclusions: As the component Mental Health seemed to be impaired for these study groups before surgery in relation to the matched reference group, nursing and doctors care actions may be of importance during the pre-operative phase. In the short perspective Health Related Quality of Life is worse for OR patients than the EVAR group but in the long term perspective improvements beyond preoperative status can only be seen with OR patients.

Preoperative Methylprednisolone Enhances Recovery After Endovascular Aortic Repair

“…In this context, the literature is inconclusive because some centers have reported a short LOS and even an outpatient procedure in selected EVAR patients 11,12 in contrast to other reports of LOS of more than 4 days. 4,5,9,13,14 Several trials have demonstrated a reduction in the inflammatory response, postoperative nausea and vomiting, and pain by administration of preoperative glucocorticoids. [15][16][17][18][19] Although glucocorticoids have been used in EVAR, 11,20 this approach has not been tested in a randomized setting.…”

Developing and evaluating an instrument to measure Recovery After INtensive care: the RAIN instrument

“…Evaluating and measuring recovery following IC is complicated as many factors may influence the patients’ own opinions about their recovery. In post-surgical and ICU follow ups, HRQL has been used in order to measure patients’ opinions on their quality of life [ 12 , 13 ]. For the recovery instruments that are used, most have focused simply on physical symptoms and mental issues, omitting many other facets of recovery.…”

“…Moreover, the questionnaire was developed upon the understanding that recovery is seen as a process of regaining health, a movement towards integration even if setbacks sometimes occur. Therefore, dimensions that also reflect existential, social and spiritual life issues were seen as important as previous studies have stated these aspects impact patients’ recoveries [ 11 – 13 , 20 , 32 ]. For example, patients expressed that they felt well but, at the same time, were in need of help from family members [ 20 ] or suffered from thoughts of death and could not look forward to anything in life [ 31 ].…”

“…Recovery has been evaluated from one to several years following IC [ 11 – 14 ] or during a period immediately following discharge from the hospital [ 15 ]. Measuring health related quality of life (HRQL) has been one method to estimate patients’ recoveries [ 12 , 13 ]. Discomforting delusional memories [ 12 , 14 ] have been found in patients after hospital and ICU discharge.…”

“…Based on previous research on patients’ recovery following ICU care [ 11 – 13 , 31 , 32 ], patient interviews [ 20 ] and the thoughts and ideas about integration, health and recovery [ 28 , 30 ], basic elements in the recovery process and condition were identified by the authors. These elements were: 1) bodily – when the body has returned to an acceptable condition, and it works as it should again, thus regaining a form of freedom; 2) mentally-socially – when a person transitions from being excluded from the world of healthy people to becoming included by reaching out and interacting; 3) existentially – when a normal daily world, including routines, has developed and a revaluation of life takes place, reviewing the past but also looking forward to the future by evaluating what is meaningful; and 4) Spiritual – when they have the will to live again, are looking forward or longing for something, and are also able to share their own experiences in order to cope with their pain or suffering.…”