Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
Br J Surg. 2024 Aug 30;111(9). doi: 10.1093/bjs/znae228.
Surgical intervention for thoracic aortic aneurysms is high risk. Understanding changes in health-related quality of life before and after endovascular stent grafting and open surgical repair can aid treatment decision-making.
The Effective Treatments for Thoracic Aortic Aneurysms ('ETTAA') study (ISRCTN04044627) was a longitudinal, observational study. Adults with new/existing arch or descending thoracic aortic aneurysms greater than or equal to 4 cm in diameter were followed from 2014 to 2022. Five domains of health-related quality of life (Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression) were recorded using the EuroQoL, five dimensions, five levels ('EQ-5D-5L') questionnaire and analysed using a range of longitudinal mixed models.
Of 886 thoracic aortic aneurysm participants, 824 completed at least 2 questionnaires. Patients had slightly worse health-related quality of life than age-matched norms. Without surgery, deterioration occurred over time in Mobility (0.072/year (95% c.i. 0.042 to 0.101), P < 0.001) and Self-Care (0.039/year (95% c.i. 0.018 to 0.061), P < 0.001) in both sexes and Pain/Discomfort in women (0.069/year (95% c.i. 0.020 to 0.118), P = 0.005). For 6 weeks after endovascular stent grafting, there was a significant impairment in Self-Care (0.214 (95% c.i. 0.112 to 0.316), P < 0.001) and (for women only) in Usual Activities (0.625 (95% c.i. 0.338 to 0.911), P < 0.001), which then returned to pre-endovascular stent grafting levels. Six weeks after open surgical repair, the impairment in health-related quality of life was greater (Mobility 0.492 (95% c.i. 0.314 to 0.669), Self-Care 0.474 (95% c.i. 0.364 to 0.583), Usual Activities 1.469 (95% c.i. 1.042 to 1.896), and Pain/Discomfort 0.561 (95% c.i. 0.363 to 0.760), all P < 0.001) and took longer to return to pre-open surgical repair levels, partly due to increased complications and longer hospitalization. Anxiety/Depression decreased after open surgical repair (-0.214 (95% c.i. -0.326 to -0.101), P < 0.001). Age, sex, frailty, smoking, New York Heart Association class, and chronic obstructive pulmonary disease were significantly associated with health-related quality of life.
Without intervention, health-related quality of life declines as age increases. Changes in health-related quality of life should contribute to surgical treatment decision-making.
胸主动脉瘤的手术干预风险很高。了解血管内支架移植和开放手术修复前后与健康相关的生活质量的变化，可以帮助治疗决策。
“胸主动脉瘤有效治疗研究”（ETTAA）是一项纵向观察性研究。从 2014 年到 2022 年，新的/现有的弓或降主动脉瘤直径大于或等于 4cm 的成年人参与了研究。使用 EuroQoL 五维健康量表（EQ-5D-5L）问卷记录了五个与健康相关的生活质量领域（行动能力、自理能力、日常活动、疼痛/不适和焦虑/抑郁），并使用一系列纵向混合模型进行了分析。
在 886 名胸主动脉瘤患者中，824 名至少完成了 2 份问卷。患者的健康相关生活质量比年龄匹配的正常值略差。没有手术，两性的行动能力（0.072/年（95%置信区间 0.042 至 0.101），P<0.001）和自理能力（0.039/年（95%置信区间 0.018 至 0.061），P<0.001）以及女性的疼痛/不适（0.069/年（95%置信区间 0.020 至 0.118），P=0.005）都会随着时间的推移而恶化。血管内支架移植后 6 周，自理能力（0.214（95%置信区间 0.112 至 0.316），P<0.001）和（仅女性）日常活动能力（0.625（95%置信区间 0.338 至 0.911），P<0.001）显著受损，然后恢复到血管内支架移植前的水平。开放手术后 6 周，健康相关生活质量的下降更为明显（行动能力 0.492（95%置信区间 0.314 至 0.669），自理能力 0.474（95%置信区间 0.364 至 0.583），日常活动能力 1.469（95%置信区间 1.042 至 1.896），疼痛/不适 0.561（95%置信区间 0.363 至 0.760），均 P<0.001），恢复到开放手术前的水平需要更长的时间，部分原因是并发症增加和住院时间延长。开放手术后焦虑/抑郁减少（-0.214（95%置信区间 -0.326 至 -0.101），P<0.001）。年龄、性别、虚弱、吸烟、纽约心脏协会（NYHA）分级和慢性阻塞性肺疾病（COPD）与健康相关生活质量显著相关。
没有干预的情况下，随着年龄的增长，健康相关的生活质量会下降。健康相关生活质量的变化应该有助于手术治疗决策。
