Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
J Endovasc Ther. 2021 Dec;28(6):852-859. doi: 10.1177/15266028211028222. Epub 2021 Jun 30.
Complex endovascular aortic repair (EVAR) procedures provide a treatment option for patients with aortic aneurysms involving visceral branches. Good technical results and short-term outcomes have been reported. Whether complex EVAR provides acceptable outcomes is not clear. The current study aims to describe postoperative functional outcomes in complex EVAR patients-an older and relatively frail patient group.
A single-center retrospective cohort study was performed, using data from a computerized database of consecutive patients who underwent complex EVAR in the Leiden University Medical Center (LUMC, The Netherlands) between July 2013 and September 2020. As of May 2017, patients scheduled for complex EVAR were referred to a geriatric care pathway to determine (Instrumental) Activities of Daily Living ((I)ADL) scores at baseline and, if informed consent was given, after 12 months. For the total patient group, adverse functional performance outcomes were: discharge to a nursing home and 12-month mortality. For the patients included in geriatric follow-up, the additional outcome was the incidence of functional decline (defined by a ≥2 point increase in (I)ADL-score) at 12-month follow-up.
Eighty-two patients underwent complex EVAR, of which 68 (82.9%) were male. Mean age was 73.3 years (SD=6.3). Within 30 days postsurgery, 6 patients (7.3%) died. Mortality within 12 months for the total patient group was 14.6% (n=12). After surgery, no patients had to be discharged to a nursing home. Fifteen patients (18.3%) were discharged to a rehabilitation center. Twenty-three patients gave informed consent and were included in geriatric follow-up. Five patients (21.7%) presented functional decline 12 months postsurgery and 4 patients had died (17.4%) by that time. This means that 39.1% of the patients in the care pathway suffered an adverse outcome.
To our knowledge, this is the only study that examined functional performance after complex EVAR, using a prospectively maintained database. No patients were newly discharged to a nursing home and functional performance results at 12 months are promising. Future multidisciplinary research should focus on determining which patients are most prone to deterioration of function, so that efforts can be directed toward preventing postoperative functional decline.
复杂的血管内主动脉修复（EVAR）手术为涉及内脏分支的主动脉瘤患者提供了一种治疗选择。已有报道称，该手术具有良好的技术效果和短期结果。然而，目前尚不清楚复杂 EVAR 是否能提供可接受的长期结果。本研究旨在描述复杂 EVAR 患者（一个年龄较大且相对虚弱的患者群体）术后的功能结果。
采用单中心回顾性队列研究，使用 2013 年 7 月至 2020 年 9 月期间在莱顿大学医学中心（荷兰）接受复杂 EVAR 治疗的连续患者的计算机数据库中的数据。自 2017 年 5 月起，计划接受复杂 EVAR 的患者被转至老年护理途径，以确定基线时（工具）日常生活活动（IADL）评分，并在获得知情同意后于 12 个月时进行评估。对于总患者组，不良功能表现结果为：出院至疗养院和 12 个月死亡率。对于接受老年随访的患者，额外的结果是 12 个月随访时功能下降的发生率（定义为 IADL 评分增加≥2 分）。
82 例患者接受了复杂 EVAR，其中 68 例（82.9%）为男性。平均年龄为 73.3 岁（标准差=6.3）。术后 30 天内，6 例（7.3%）患者死亡。总患者组的 12 个月死亡率为 14.6%（n=12）。手术后，无患者需要出院至疗养院。15 例（18.3%）患者出院至康复中心。23 例患者同意并接受老年随访。术后 12 个月时，5 例（21.7%）患者出现功能下降，4 例（17.4%）患者死亡。这意味着护理途径中的 39.1%的患者出现了不良结果。
据我们所知，这是唯一一项使用前瞻性维护数据库检查复杂 EVAR 后功能表现的研究。没有患者新出院至疗养院，12 个月时的功能表现结果令人鼓舞。未来的多学科研究应重点确定哪些患者最容易出现功能恶化，以便努力预防术后功能下降。
