Differences in the evolution of health status and quality of life through the first year after infrarenal endovascularaneurysm repair.

Abstract

To evaluate longitudinal changes in quality of life (QoL) and health status (HS) in patients with an abdominal aortic aneurysm undergoing endovascular aneurysm repair (EVAR). This prospective international multicenter cohort study included patients undergoing elective infrarenal EVAR in 21 institutions. QoL (World Health Organization Quality of Life-Brief [WHOQOL-BREF] questionnaire) and HS (12-Item Short Form Survey questionnaire) were assessed preoperatively and postoperatively at 6 and 12 months. Preset minimal clinically important difference (MCID) thresholds defined meaningful changes in QoL or HS for each patient. Linear mixed models evaluated longitudinal changes for the whole cohort. In total, 151 patients were included (mean age 74.4 ± 6.6 years). At 12 months, MCID-based individual-patient analysis demonstrated that QoL domains were higher in 14% to 31% and lower in 21% to 45% and that HS summary scores were higher in 26% to 29% and lower in 38%. In linear mixed models, environmental QoL was significantly lower at 6 and 12 months (mean difference -0.45 [95% confidence interval (CI): -0.05; -0.84, P = .021] and -0.44 [95% CI: -0.05; -0.84, P = .024]) and social QoL at 12 months (mean difference -0.62 [95% CI: -0.11; -1.12, P = .010]) compared with baseline, whereas no significant differences were observed in HS. QoL measures (WHOQOL-BREF) indicated significant differences in social and environmental QoL domains after EVAR when compared with baseline, whereas HS measures (12-Item Short Form Survey) did not reflect statistically significant changes. This suggests that QoL and HS capture different concepts of patient well-being after EVAR and that HS measures alone may not reflect what patients value. MCID-based individual analysis demonstrated substantial heterogeneity in QoL and HS trajectories. These findings may support shared decision-making by informing patients about expected postoperative trajectories. Long-term evaluations that incorporate frailty and multimorbidity are warranted.