Major aortic surgery improves quality of life, but gains fade over time
A review of eight studies reveals that patients undergoing thoracoabdominal aortic aneurysm repair experience initial improvements in quality of life—but the benefits don't always persist long-term. The finding matters for hospitals and insurers weighing surgical intervention costs against patient outcomes, and for clinical guidelines that currently lack clear guidance on quality-of-life expectations.
Originaltitel: Health Related Quality of Life Following Intervention for Thoracoabdominal Aortic Aneurysm: a Systematic Review and Narrative Synthesis
<p><strong>BACKGROUND:</strong> Thoracoabdominal aortic aneurysms (TAAA) pose significant risks of morbidity and mortality. Considering the evolving techniques for TAAA intervention and the growing interest in quality of life (QoL) outcomes for decision-making, we aimed to evaluate the impact of patient and perioperative characteristics on short-, medium-, and long-term post-operative QoL in TAAA repair patients.</p><p><strong>METHODS:</strong> A systematic search was conducted in CINAHL, APA PsycINFO, EMBASE, Medline and Cochrane to identify primary research studies evaluating QoL post TAAA surgery, published in English or Swedish between 01 January 2012 and 26 September 2022. A narrative synthesis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of evidence was assessed using the Critical Appraisal Skills Programme and Joanna Briggs Institute checklists.</p><p><strong>RESULTS:</strong> Eight studies of low or moderate quality with 455 patients were included. Preoperative QoL in TAAA patients was lower compared to the general population. While there is an initial short-term improvement in post-operative QoL, patients fail to reach baseline levels even after seven years, with physical activity and functioning domains being particularly affected. Experiencing post-operative complications, including paraplegia and cardiovascular events, negatively impacts post-operative QoL. Patients with uncomplicated postoperative status had improved QoL. Prolonged hospital stay negatively affects physical functioning.</p><p><strong>CONCLUSIONS:</strong> Individuals with TAAA are likely to have lower baseline QoL compared to the general population. Following TAAA repair, post-operative QoL may remain lower than baseline levels, persisting over the long-term. Comorbidities, post-operative complications, and hospitalisation duration appear to exert adverse effects on post-operative QoL.</p>