Early Quality of Recovery After Endovascular Versus Open Abdominal Aortic Aneurysm Repair

To compare early postoperative quality of recovery after endovascular (EVAR) versus open (OSR) repair for infrarenal abdominal aortic aneurysm (AAA) using the Quality of Recovery-15 (QoR-15) questionnaire, interpreting between-group differences against the published minimal clinically important difference (MCID) for this instrument.

All patients undergoing elective EVAR or OSR between January 2023 and January 2025 were prospectively enrolled. QoR-15 was recorded at baseline, hospital discharge, and one month, and analyzed with a linear mixed-effects model (group, time, and their interaction; random intercept per patient). Because the groups differed at baseline in several characteristics, a second, covariate-adjusted model added age, ASA class ≥3, history of ischemic heart disease, peripheral arterial disease, and hypertension as fixed effects.

A total of 141 patients were analyzed (EVAR n = 62, OSR n = 79). Thirty-day mortality was 1.6% in the EVAR group and 0% in the OSR group. QoR-15 scores changed significantly over time (p < .001) and were higher overall in the EVAR group (p = .016). At discharge, the between-group difference was 10 points favoring EVAR (p = .001), exceeding the published MCID of 8 points and supporting clinical as well as statistical significance. This advantage was absent at baseline (2 points; p = .332) and at one month (4 points; p = .135), both below the MCID. After adjustment for age, ASA class, ischemic heart disease, peripheral arterial disease, and hypertension, the discharge difference remained unchanged (10.0 points, 95% CI 1.6-18.4; p = .020), and the averaged group effect stayed significant (F (1,131) = 4.60; p = .034). The group × time interaction was non-significant in both models (unadjusted p = .052; adjusted p = .101).

EVAR was associated with a discharge-time advantage in patient-reported recovery that exceeded the MCID for QoR-15, and this advantage persisted after covariate adjustment but resolved by one month. These findings support patient-reported recovery as a clinically meaningful complementary outcome after AAA repair, although the non-randomized design warrants confirmation in a larger study.