A Prospective Evaluation of Patient Reported Outcomes after Aortic Aneurysm Repair.

Abstract

A better understanding of the patient's perspective is required for optimal management of aortic aneurysms. This study aimed to assess changes in disease specific quality of life (QOL), symptom burden, and treatment satisfaction before and after elective aortic aneurysm repair using patient reported outcome measures. This was a single centre, prospective, observational study. Patients undergoing elective aortic aneurysm repair were assessed pre-operatively (baseline) and at six weeks, six months, and 12 months post-operatively using aneurysm-specific patient reported outcome measures. QOL, symptom burden, and treatment satisfaction were analysed. One hundred and fifty-three patients were included, of which 128 (83.7%) were men. The median age was 75 [interquartile range (IQR) 69, 79] years. Open repair (OR) was performed in 33 (21.6%) patients, standard endovascular aneurysm repair (EVAR) in 51 (33.3%), and fenestrated and or branched EVAR in 69 (45.1%). Disease specific QOL improved after repair (pre-operative median average weighted impact score = -2.0 [-4, -0.6] vs. -0.9 [-3.4, -0.5] at six weeks, -1.1 [-2.3, -0.1] at six months, and -0.7 [-1.7, -0.1] at 12 months, p = .001). OR had a greater early negative impact on QOL (-3.4 [-5.5, -1.8]) compared with standard EVAR (-0.8 [-1.9, -0.2]), or fenestrated and or branched EVAR (-0.9 [-2.7, -0.7], p = .001). Symptom burden increased initially (19 [9, 37] pre-operative vs. 27 [16.5, 39.5] at six weeks) but improved at six months (17.5 [8, 29.5]) and 12 months (16 [6.5, 25.5], p = .001). More than 90% of patients were satisfied with their treatment, although improved feedback on surveillance imaging was identified as an area for improvement. Aortic aneurysm repair not only prevents rupture but also has a positive impact on QOL irrespective of treatment modality. These findings support a more patient centred approach to aneurysm management and will inform future patient selection strategies.