Longitudinal health-related quality of life in people with thoracic aortic aneurysms.

IF 8.6 1区医学 Q1 SURGERY

British Journal of Surgery Pub Date : 2024-08-30 DOI:10.1093/bjs/znae228

Linda D Sharples,Vasiliki Anagnostopoulou,Anna L Pouncey,Carol Freeman,Andrew McCarthy,Joanne Gray,Peter McMeekin,Priya Sastry,Luke Vale,Colin Bicknell,Stephen R Large

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引用次数: 0

Abstract

BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.

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胸主动脉瘤患者的纵向健康相关生活质量。

背景胸主动脉瘤的手术治疗风险很高。方法胸主动脉瘤的有效治疗（ETTAA）研究（ISRCTN04044627）是一项纵向观察性研究。从 2014 年到 2022 年，对患有直径大于或等于 4 厘米的新发/现有拱形或降主动脉瘤的成年人进行了跟踪调查。使用EuroQoL五维五级（"EQ-5D-5L"）问卷记录健康相关生活质量的五个领域（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分析。结果在886名胸主动脉瘤参与者中，有824人至少完成了2份问卷。患者的健康相关生活质量略低于年龄匹配的标准值。在未进行手术的情况下，随着时间的推移，男女患者的行动能力（0.072/年（95% 置信区间：0.042-0.101），P <0.001）和自理能力（0.039/年（95% 置信区间：0.018-0.061），P <0.001）以及女性患者的疼痛/不适（0.069/年（95% 置信区间：0.020-0.118），P = 0.005）均有所下降。血管内支架移植术后 6 周，自理能力（0.214（95% 置信区间：0.112 至 0.316），P＜0.001）和（仅限女性）日常活动能力（0.625（95% 置信区间：0.338 至 0.911），P＜0.001）显著下降，随后恢复到血管内支架移植术前的水平。开放手术修复六周后，与健康相关的生活质量受损程度更大（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 1.469（95% 置信区间：1.042 至 1.583）。i.1.042至1.896）和疼痛/不适0.561（95% c.i.0.363至0.760），所有P均<0.001），需要更长时间才能恢复到开腹手术修复前的水平，部分原因是并发症增加和住院时间延长。开放性手术修复后，焦虑/抑郁程度下降（-0.214（95% 置信区间：-0.326 至 -0.101），P <0.001）。年龄、性别、虚弱程度、吸烟、纽约心脏协会分级和慢性阻塞性肺病与健康相关生活质量显著相关。健康相关生活质量的变化应有助于手术治疗决策。

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来源期刊

British Journal of Surgery 医学-外科

CiteScore

12.70

自引率

7.30%

发文量

1102

审稿时长

1.5 months

期刊介绍： The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.