Quality of life following surgery for abdominal aortic aneurysm

Abstract

Repair of abdominal aortic aneurysm (AAA) carries a considerable rate of morbidity and mortality, but little information exists on the quality of life following this procedure. During 1988 and 1989, in two hospitals, 211 patients (186 men and 25 women; median age 74 (range 48-87) years) underwent surgery for AAA. There were 77 ruptured aneurysms and 134 electively repaired. Of these, 38 patients died in hospital (27 ruptured, 11 elective); by the time of review a further eight (one ruptured, seven elective) had died from unrelated causes. Of the 165 survivors, 131 (45 ruptured, 86 elective) were reviewed and questioned as to their physical and mental state before and after surgery. Using the Rosser index, a value for quality of life before and after surgery was calculated (1.0, good; 0, dead). The value for the elective group was 0.94 before operation and 0.96 after, but in the ruptured group fell from 0.98 before surgery to 0.87 afterwards. This study shows that patients undergoing elective surgery for repair of AAA retain good quality of life. By contrast, patients surviving emergency surgery following this procedure seem to suffer a deterioration in life quality, which must be endured for the same expected lifetime as that for the elective group. These results support the need for a national AAA ultrasonographic screening programme.

Long term relative survival after surgery for abdominal aortic aneurysm in Western Australia: population based study

“…These data support a policy of elective surgery given the cumulative risk of rupture of an abdominal aortic aneurysm (>5 cm in diameter), and the case fatality from rupture is 80%. 9 29 Although we do not address quality of life there is evidence that patients undergoing elective surgery for repair of abdominal aortic aneurysm retain good quality of life 30. The results in women are more difficult to interpret because of small numbers.…”

Decision-analytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneurysm in 65-year-old men

“…In a sensitivity analysis, individuals diagnosed with an AAA were assigned a decrement in quality of life of 0·071, employing a gamma distribution: gamma(12·6, 0·01). Furthermore, no long‐term negative effects on quality of life have been demonstrated in individuals who survive emergency or elective surgery, and hence no quality adjustment in the postoperative state was included in the base‐case analysis40–48. In a sensitivity analysis, individuals in the postoperative state were assigned a utility decrement of 0·1, employing a gamma distribution: gamma(16, 0·01).…”

Ruptured Abdominal Aortic Aneurysms

“…Of patients with renal failure, 11-40% require postoperative dialysis with an associated mortality rate of 76-89% (Harris et al, 1991;Magee et al, 1992). Impairment in renal function has been associated with suprarenal cross-clamping, duration of cross clamping >30 minutes, preexisting conditions of renal dysfunction (serum creatinine > 2 mg/dl), shock, and age over 80 (Bonventre 2007;Nicholson et al, 1996).…”

“…This seems to be a very real possibility, in fact, for survivors of AAA repair, given the high operative morbidity and mortality rates. The most frequently used questionnaires are the Rosser index (Korhonen et al, 2003;Joseph et al, 2002) patients who underwent elective repair (Magee et al, 1992;Hennessy et al, 1998). Biases emerged in these reports as the studies were small and the patients were not matched for comorbidities, so it is difficult to ascertain if the populations (elective vs emergency) were similar.…”