Characterising recovery following abdominal aortic aneurysm repair using cardiopulmonary exercise testing and patient reported outcome measures

Dodds, N.; Angell, J.; Lewis, S. L.; Pyke, M.; White, P.; Darweish Medniuk, A; Mitchell, D. C.; Tolchard, S.

Abstract

Purpose: Surgery is associated with a post-operative stress response, changes in cardiopulmonary reserve, and metabolic demand. Here recovery after abdominal aortic aneurysm repair is investigated using cardiopulmonary exercise testing and patient-reported questionnaires. Materials and methods: Patients undergoing open (n = 21) or endovascular (n = 21) repair undertook cardiopulmonary exercise tests, activity, and health score questionnaires pre-operatively and, 8 and 16 weeks, post-operatively. Oxygen uptake and ventilatory parameters were measured, and routine blood tests were undertaken. Results: Recovery was characterised by falls in anaerobic threshold, peak oxygen uptake, and oxygen pulse at 8 weeks which appeared to be associated with operative severity; the fall in peak oxygen uptake was greater following open vs. endovascular repair (3.5 vs. 1.6 ml.kg−1.min−1) and anaerobic threshold showed a similar tendency (3.1 vs. 1.7 ml.kg−1.min−1). In the smaller number of patients re-tested these changes resolved by 16 weeks. Reported health and activity did not change. Conclusions: Aortic repair is associated with falls in the anaerobic threshold, peak oxygen uptake, and oxygen pulse of a magnitude that reflects operative severity and appears to resolve by 16 weeks. Thus, post-operatively patients may be at higher risk of further metabolic insult e.g. infection. This further characterises physiological recovery from aortic surgery and may assist in defining post-operative shielding time.IMPLICATIONS FOR REHABILITATION Abdominal aortic aneurysm repair is a life-saving operation, the outcome from which is influenced by pre-operative cardiopulmonary reserve; individuals with poor reserve being at greater risk of peri-operative complications and death. However, for this operation, the physiological impact of surgery has not been studied. In a relatively small sample, this study suggests that AAA repair is associated with a significant decline in cardiopulmonary reserve when measured 8 weeks post-operatively and appears to recover by 16 weeks. Moreover, the impact may be greater in endovascular vs. open repair.

• Journal Article Type: Article
• Acceptance Date: Mar 15, 2022
• Online Publication Date: Mar 29, 2022
• Publication Date: Mar 1, 2023
• Deposit Date: Mar 16, 2022
• Publicly Available Date: Mar 30, 2023
• Journal: Disability and Rehabilitation
• Print ISSN: 0963-8288
• Electronic ISSN: 1464-5165
• Publisher: Taylor & Francis
• Peer Reviewed: Peer Reviewed
• Volume: 45
• Issue: 3
• Pages: 1178-1184
• DOI: https://doi.org/10.1080/09638288.2022.2055162
• Keywords: Abdominal aortic aneurysm; recovery; cardiopulmonary exercise testing; shielding; physiological burden
• Public URL: https://uwe-repository.worktribe.com/output/9210292