Health Related Quality of Life after Treatment of Abdominal Aortic Aneurysm with Open and Endovascular Techniques—A Two-Year Follow Up

Monica Pettersson, Ingegerd Bergbom, Erney Mattsson

Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

DOI: 10.4236/ss.2012.39087                

Abstract

Background: Patients with Abdominal Aortic Aneurysm can be treated with two different surgical methods: Open repair (OR) or Endovascular Aortic Repair (EVAR). These two different treatments can probably result in different sense of Health related Quality of life, both in a short term and a long term perspective. The purpose of this prospective study was to examine patients’ Health related Quality of life after surgical treatment of Abdominal Aortic Aneurysm over two years using different instruments for the observations. Methods: Patients were invited consecutively to answer questionnaires before operation, and 1, 12 and 24 months after surgery. The study was conducted by using the Health related Quality of life questionnaires Short Form (SF-36) and Nottingham Health Profile (NHP). 76 patient (40 in the OR and 36 in the EVAR group) participated in the study. The mean age in the OR group were 68 years, range 52 - 80 and in the EVAR group 75 years, range 65 - 85. The results from these two groups of patients were compared to a matched reference group. Results: Patients treated with EVAR rated their Health related Quality of life significantly lower in the domain of Mental Health and Mental Component Score in relation to a matched reference population before surgery. This difference was not present two years after intervention. After one month Health related qualities of life were worse for the OR group. After two years significant improvements in relation to baseline were observed only among patients in the OR group. No such long-term benefits were seen in the EVAR group. Conclusions: As the component mental health seemed to be impaired for these study group before surgery in relation to the matched reference group, nursing and doctors care actions may be of importance during the pre-operative phase. In the short perspective Health related Quality of life is worse for OR patients than the EVAR group but in the long term perspective improvements beyond preoperative status can only be seen with OR patients.

Keywords

Advanced Practice; Vascular Surgery; Health Related Quality of Life; Vascular Disease; Abdominal Aortic Aneurysm

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. D. Blankensteijn, et al., “Dutch Randomized Endovascular Aneurysm Management (Dream Trial Group), Two Year Outcomes after Conventional or Endovascular Repair of Abdominal Aortic Aneurysm,” New England Journal Medicine, Vol. 23, No. 352, 2005, pp. 352-405.
[2]	EVAR 1 Trial Participants, “Endovascular Aneurysm Repair versus Open Repair in Patients with Abdominal Aortic Aneurysm (EVAR Trial 1): Randomised Controlled Trial,” Lancet, Vol. 365, No. 9478, 2005, pp. 2179-2186. doi:10.1016/S0140-6736(05)66627-5
[3]	R. M. Sandfjord, et al., “Endovascular Abdominal Aortic Aneurysm Repair: 5-Year Follow-Up Results,” Annals of Vascular Surgery, Vol. 3, No. 22, 2008, pp. 372-378.
[4]	A. J. Lloyd, et al., “Comparison of Cognitive Function and Quality of Life after Endovascular or Conventional Aortic Aneurysm Repair,” British Journal of Surgery, Vol. 87, No. 4, 2000, pp. 443-447. doi:10.1046/j.1365-2168.2000.01428.x
[5]	M. Malina, et al., “Quality of Life before and after Endovascular and Open Repair of Asymptomatic AAAs: A Prospective Study,” Journal of Endovascular Therapy, Vol. 7, No. 7, 2000, pp. 372-379. doi:10.1583/1545-1550(2000)007<0372:QOLBAA>2.0.CO;2
[6]	J. L. Ballard, et al., “Quality of Life before and after Endovascular and Retroperitoneal Abdominal Aortic Aneurysm Repair,” Journal of Vascular Surgery, Vol. 4, No. 39, 2001, pp. 797-803.
[7]	R. V. Aquino, et al., “Quality of Life Assessment in Patients Undergoing Endovascular or Conventional AAA Repair,” Journal of Endovascular Therapy, Vol. 8, No. 58, 2001, pp. 521-528. doi:10.1583/1545-1550(2001)008<0521:QOLAIP>2.0.CO;2
[8]	P. E. Lottman, et al., “Health—Related Quality of Life Outcomes Following Elective Open Repair or Endovascular AAA Repair,” Journal of Endovascular Therapy, Vol. 11, No. 3, 2004, pp. 23-29. doi:10.1583/03-1141.1
[9]	M. Prinssen, et al., “Quality of Life after Endovascular and Open AAA Repair. Results of a Randomised Trial,” Journal of Vascular Surgery, Vol. 27, No. 2, 2004, pp. 121-127.
[10]	B. Aljabri, et al., “Patient-Reported Quality of Life after Abdominal Aortic Aneurysm Surgery: A Prospective Comparison of Endovascular and Open Repair,” Journal of Vascular Surgery, Vol. 44, No. 6, 2006, pp. 1182-1187. doi:10.1016/j.jvs.2006.08.015
[11]	F. Dick, et al., “Outcome and Quality of Life in Patients Treated for Abdominal Aortic Aneurysms: A Single Center Experience,” World Journal of Surgery, Vol. 6, No. 6, 2008, pp. 987-994. doi:10.1007/s00268-008-9565-1
[12]	N. Muszbek, et al., “Systematic Review of Utilities in Abdominal Aortic Aneurysm,” European Journal of Vascular and Endovascular Surgery, Vol. 3, No. 36, 2008, pp. 283-289. doi:10.1016/j.ejvs.2008.03.018
[13]	H.-G. Gadamer, “Truth and Method,” Continuum, New York, 1989.
[14]	V. Frankl, “Livet Maste ha Mening (Mans Search for Meaning),” Natur & Kultur, Stockholm, 1986.
[15]	World Health Organisation, “WHOQOL Study Protocol: The Development of the World Health Organisation Quality of Life Assessment Instrument: Publication MNH/ PSF/93.9 Geneva, Switzerland: Division of Mental Health,” World Health Organization, 1993.
[16]	K. Eriksson, “The Theory of Caritative Caring: A Vision” Nursing Science Quarterly, Vol. 3, No. 20, 2007, pp. 201-202. doi:10.1177/0894318407303434
[17]	R. Klevsgard, et al., “Nottingham Health Profile and Short-Form 36 Health Survey Questionnaires in Patients with Chronic Lower Limb Ischemia: Before and after Revascularization,” Journal of Vascular Surgery, Vol. 2, No. 36, 2002, pp. 310-317.
[18]	J. E. Ware and C. D. Shelbourne, “The MOS 36-Item Short-Form Health Survey (SF-36) Conceptual Framework and Item Selection,” Medicine Care, Vol. 30, No. 6, 1992, pp. 473-484. doi:10.1097/00005650-199206000-00002
[19]	J. E. Brazier, et al., “Validating the SF-36 Health Survey Questionnaire: New Outcome Measure for Primary Care,” British Medical Journal, Vol. 6846, No. 305, 1992, pp. 160-164.
[20]	WHO-QOL, “Study Protocol for the World Health Organisation Project to Develop Quality of Life Assessment Instrument,” Quality of Life Research, Vol. 2, No. 2, 1993, pp. 153-159. doi:10.1007/BF00435734
[21]	S. M. Hunt and J. McEwen, “The Development of a Subjective Indication,” Sociol Health Illness, Vol. 3, No. 2, 1980, pp. 231-246. doi:10.1111/1467-9566.ep11340686
[22]	S. M. Hunt, et al., “Reliability of a Population Survey Tool for Measuring Perceived Health Problems: A Study of Patients with Osteoarthrosis,” Epidemiology Community Health, Vol. 35, No. 4, 1981, pp. 185-188. doi:10.1136/jech.35.4.297
[23]	B. G. Derubertis, et al., “Abdominal Aortic Aneurysm in Women: Prevalence, Risk Factors, and Implications for Screening,” Journal of Vascular Surgery, Vol. 4, No. 46, 2007, pp. 630-635. doi:10.1016/j.jvs.2007.06.024
[24]	N. Mantel, “Chi-Square Tests with One Degree of Freedom; Extension of the Mantel-Haenszel Procedure,” Journal of the American Statistical Association, Vol. 58, No. 303, 1963, pp. 690-700. doi:10.2307/2282717
[25]	M. Sullivan and C. Taft, “SF-36 Health Survey Manual and Interpretation Guide 2: Edition,” Goteborg University, Gothenburg, 2002.
[26]	M. Pettersson, et al., “Prospective Follow-Up of Sexual Function after Elective Repair of Abdominal Aortic Aneurysm Using Open and Endovascular Techniques,” Journal of Vascular Surgery, Vol. 50, No. 3, 2009, pp. 492-499. doi:10.1016/j.jvs.2009.02.245
[27]	L. Berg, et al., “Caring Relationship in a Context-Field-Work in a Medical Ward,” International Journal of Nursing Practice, Vol. 3, No. 12, 2007, pp. 100-106.