Aljabri Badr, Al Wahaibi Khalifa, Abner Deborah, Mackenzie Kent S, Corriveau Marc-Michel, Obrand Daniel I, Meshefedjian Garbis, Steinmetz Oren K
Division of Vascular Surgery, McGill University, Montréal, Québec, Canada.
J Vasc Surg. 2006 Dec;44(6):1182-1187. doi: 10.1016/j.jvs.2006.08.015.
This study evaluated and compared changes over time in health-related quality of life reported by patients with infrarenal abdominal aortic aneurysm (AAA) undergoing elective endovascular (EVAR) and open aneurysm (OR) repair.
A prospective, nonrandomized cohort of 76 patients (62 men, 14 women; age range, 42 to 89 years) undergoing elective, infrarenal AAA repair (EVAR, n = 43; OR, n = 33) at two university teaching hospitals during a 15-month period were administered the Medical Outcomes Study Short-Form 36-item (SF-36) health survey preoperatively and then 1 week, 1 month, and 6 months postoperatively. Patient demographics, procedural details, postoperative follow-up data, and SF-36 scores were compared between groups.
Both groups had total SF-36 scores that were significantly lower than preoperative scores at 1 week and 1 month after surgery but were not significantly different from the preoperative scores at 6 months (OR 66.2 +/- 21.1 to 72.3 +/- 19.8, P > .1; and EVAR 61.0 +/- 17.7 to 58.7 +/- 19.4, P > .1). Six-month total SF-36 scores were significantly higher in the OR group compared with the EVAR group (mean 72.3 +/- 19.8 OR vs 58.7 +/- 19.4 EVAR; P = .009). In the postoperative period, a significant drop occurred in mean scores in six of the eight domains of the SF-36 in the OR patients (physical function, PF; role physical, RP; bodily pain, BP; vitality, VT; social function, SF; role emotional, RE) and five domains for EVAR patients (PF, RP, BP, SF, RE). In two domains, RE and PF, scores returned to baseline values significantly sooner in EVAR patients than in OR patients (RE, EVAR 1 month vs OR 6 months; and PF, EVAR 1 month vs OR 6 months). In the VT domain, no significant postoperative drop occurred in the EVAR group, but in the OR group, mean scores were significantly lower at 1 week and 1 month compared with preoperative values. In the domains of general health and mental health, no significant drop occurred in SF-36 score postoperatively in either group.
Patient reported health-related quality of life after infrarenal AAA repair is significantly impaired in the early postoperative period but returns to baseline by 6 months in patients treated with EVAR and OR. Patients having EVAR had significantly more rapid return to preoperative scores in selected domains of the SF-36. Even though EVAR is associated with shorter and less invasive perioperative hospital course and fewer postoperative complications, EVAR patients had lower quality of life scores 6 months after surgery than OR patients.
本研究评估并比较了接受择期血管腔内修复术（EVAR）和开放性动脉瘤修复术（OR）的肾下腹主动脉瘤（AAA）患者随时间推移报告的健康相关生活质量变化。
在15个月期间，对两家大学教学医院中76例接受择期肾下AAA修复术（EVAR组43例；OR组33例）的患者（62例男性，14例女性；年龄范围42至89岁）进行前瞻性、非随机队列研究，术前以及术后1周、1个月和6个月对其进行医学结局研究简明健康调查36项量表（SF - 36）测评。比较两组患者的人口统计学资料、手术细节、术后随访数据及SF - 36评分。
两组患者术后1周和1个月时SF - 36总分均显著低于术前评分，但术后6个月时与术前评分无显著差异（OR组从66.2±21.1降至72.3±19.8，P＞0.1；EVAR组从61.0±17.7降至58.7±19.4，P＞0.1）。OR组术后6个月的SF - 36总分显著高于EVAR组（OR组均值72.3±19.8，EVAR组均值58.7±19.4；P = 0.009）。术后，OR组患者SF - 36八个领域中的六个领域（生理功能，PF；角色生理，RP；身体疼痛，BP；活力，VT；社会功能，SF；角色情感，RE）以及EVAR组患者五个领域（PF、RP、BP、SF、RE）的平均得分均显著下降。在两个领域，即RE和PF方面，EVAR组患者得分恢复至基线值的时间明显早于OR组患者（RE领域，EVAR组1个月，OR组6个月；PF领域，EVAR组1个月，OR组6个月）。在VT领域，EVAR组术后无显著下降，但OR组术后1周和1个月时的平均得分与术前相比显著降低。在总体健康和心理健康领域，两组患者术后SF - 36评分均无显著下降。
肾下AAA修复术后患者报告的健康相关生活质量在术后早期显著受损，但接受EVAR和OR治疗的患者在6个月时恢复至基线水平。EVAR组患者在SF - 36部分选定领域中恢复至术前评分的速度明显更快。尽管EVAR与围手术期住院时间短、侵入性小以及术后并发症少相关，但EVAR组患者术后6个月的生活质量评分低于OR组患者。
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