Sex as a Modifier of Health-Related Quality of Life, Illness Acceptance, and Psychological Distress in Patients After Aortic Aneurysm Repair: A 2-Year Prospective Study.

Abstract

Introduction: Women constitute a minority of patients undergoing aortic aneurysm repair, yet available data suggest a worse quality of life and a higher burden of perioperative anxiety in this group. Prospective, multi-timepoint data comparing the sexes in Polish clinical centres are virtually absent. We assessed whether sex modifies quality of life, illness acceptance, and psychological distress over 2 years following aortic aneurysm repair.

Material and methods: In this prospective, single-centre cohort study, 150 consecutive patients (113 men, 37 women; mean age 69.9, SD 8.1 years) treated for aortic aneurysm between 2021 and 2024 completed the WHOQOL-Bref, the Acceptance of Illness Scale (AIS) and the Hospital Anxiety and Depression Scale, Polish modified version (HADS-M), immediately after surgery and at 6 months, 1 year and 2 years. The cohort was unrestricted with respect to aneurysm extent and repair modality. The primary analysis used generalised estimating equations including sex, time and the sex-by-time interaction, adjusted for age, repair modality, urgency of admission, ischaemic heart disease and partnered status. A prespecified sensitivity analysis was restricted to infrarenal aneurysms treated by standard endovascular repair (n=94).

Results: Immediately after surgery, women scored lower than men in all four WHOQOL-Bref domains: physical 52.7 vs 60.2 (p=0.013), psychological 58.4 vs 68.1 (p=0.001), social relationships 59.0 vs 69.6 (p<0.001) and environmental 62.8 vs 67.5 (p=0.037); anxiety was higher in women (8.7 vs 7.1; p=0.035). After adjustment, the early deficit remained significant for the psychological domain (adjusted difference -9.26, 95% CI -15.54 to -2.98; p=0.004) and the social relationships domain (-9.85, 95% CI -15.95 to -3.74; p=0.002) but not for the physical or environmental domains, and the crude anxiety difference did not survive adjustment (p=0.253). Significant sex-by-time interactions indicated convergence in all domains except social relationships, for which the adjusted female deficit persisted across follow-up (-6.86, 95% CI -12.27 to -1.44; p=0.013). At 2 years no woman remained in the low illness-acceptance category compared with 20.5% of men (p=0.037); this categorical comparison rests on small and unstable cell counts and is presented as descriptive only. The sensitivity analysis reproduced and strengthened these findings.

Conclusion: Women undergoing aortic aneurysm repair report a lower quality of life in the early postoperative period, and the deficit in the social relationships domain is the one that persists over 2 years after adjustment. In the absence of a preoperative baseline and with a small female subgroup, these observations are hypothesis-generating and support the routine, sex-stratified capture of patient-reported outcome measures in aortic practice.