Patient-perceived health-related quality of life before and after laparoscopic aortobifemoral bypass

Abstract

Background: In patients operated with laparoscopic aortobifemoral bypass (LABFB) for atherosclerotic obstruction in aortoiliac segment, the main focus of the reports published during the last two decades has been morbidity and mortality. The primary objective of this study was to examine the health-related quality of life (HRQL) in these patients before and after LABFB.

Patients and methods: Fifty consecutive patients (27 females) with Trans-Atlantic Inter-Society Consensus II, type D lesions were prospectively included. Short-Form 36 (SF-36) questionnaire was used to get information about the HRQL before LABFB and at 1, 3 and 6 months after the operation. Main indication for LABFB was intermittent claudication. Linear mixed-effect models were used to assess changes in HRQL over time. Age, gender, smoking, blood loss, operation time, concomitant operation, the American Society of Anesthesiologists category, length of hospital stay, previous vascular procedures and aorta cross-clamping were used as fixed factors and their impact on the physical components of the SF-36, as well as the summary scores were determined with univariate analysis. Variables with P<0.2 were included in the multivariate regression analysis. P<0.05 was considered statistically significant.

Results: Statistically significant improvement was found in all SF-36 domains as well as in the summary scores after LABFB compared to the preoperative scores. The improvement in scores was substantial already at 1 month and the effect was maintained at 3 and 6 months survey time points. Concomitant operations had a statistically significant negative impact on the physical components of SF-36. Data completeness of item questionnaires was 93% in the whole material. Reliability scale and homogeneity estimates for the eight domains had high internal consistency.

Conclusion: Patients operated with LABFB for Trans-Atlantic Inter-Society Consensus II, type D lesions have reduced HRQL. LABFB leads to substantial and statistically significant improvement in the patients' HRQL, when examined with SF-36. These results need to be replicated by a randomized clinical trial.

Keywords: aortic surgery; aortobifemoral bypass; aortoiliac atherosclerosis; laparoscopic vascular surgery; laparoscopy; quality of life; vascular.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1

Changes in the scores (observed mean values) of individual domains in the SF-36, in 50 patients before and after laparoscopic aortobifemoral bypass for the treatment of aortoiliac occlusive disease (Trans Atlantic Inter-Society Consensus II, type D lesions). Notes: Changes in summary scores PCS and MCS are also illustrated. The vertical bars represent 95% confidence interval. Abbreviations: BP, bodily pain; GH, general health; MCS, mental component score; MH, mental health; PF, physical functioning; PCS, physical component score; RP, role limitations due to physical problems; RE, role limitations due to emotional problems; SF, social functioning; SF-36, Short-Form 36; VT, vitality.