Patient-reported Quality of Life After Elective Open and Endovascular Abdominal Aneurysm Repair: A Nonrandomized...

In many countries, endovascular aneurysm repair (EVAR) is the first preference for treating abdominal aneurysms (AAAs). However, recent National Institute and Care Excellence guidelines have added additional arguments in favor of open surgical repair (OSR). This study focuses on patient-reported quality of life using Short Form-36 (SF-36) questionnaires to obtain additional decision-making arguments for EVAR or open repair.

All consecutive patients (n = 218) that underwent elective AAA treatment (EVAR or OSR) between 2016 and 2019 were included, and were sent SF-36 questionnaires 6 weeks preoperatively and 6 weeks and 1 year postoperatively. Most patients were treated endovascularly, following Dutch guidelines. Patient characteristics, SF-36 scores, and physical component summary and mental component summary (PCS/MCS) scores were obtained and calculated. Scores were also compared to an age-matched Dutch population.

No significant differences in patient characteristics were found between the EVAR (N = 178) and OSR (N = 30) groups. Because of inclusion bias (EVAR as preferred treatment) no mutual comparison was conducted. The EVAR group showed significant increase in 4 domains of the SF-36 at 6 weeks and 1 year postoperatively. The OSR group also showed a considerable increase, albeit not statistically significant. After both EVAR and open repair, PCS and MCS scores returned to levels comparable to a healthy age-matched Dutch population.

Quality-of-life assessment is an important decision-making tool for aneurysm repair. The significant increase of baseline SF-36 scores after treatment emphasizes relief of anxiety from living with a potentially life-threatening condition. No arguments were found for quality of life in favor of one of the treatment modalities.