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A preoperative supervised exercise program potentially improves long-term survival after elective abdominal aortic aneurysm repair

Sethi, Sifut; Ravindhran, Bharadhwaj; Long, Judith; Gurung, Roji; Huang, Chao; Smith, George E.; Carradice, Daniel; Wallace, Tom; Ibeggazene, Said; Chetter, Ian C.; Pymer, Sean

Authors

Sifut Sethi

Bharadhwaj Ravindhran

Judith Long

Roji Gurung

Tom Wallace

Said Ibeggazene

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Mr Sean Pymer Sean.Pymer@hull.ac.uk
Academic Clinical Exercise Physiologist



Abstract

Objective: A preoperative supervised exercise program (SEP) improves cardiorespiratory fitness and perioperative outcomes for patients undergoing elective abdominal aortic aneurysm (AAA) repair. The aim of this study was to assess the effect of a preoperative SEP on long-term survival of these patients. A secondary aim was to consider long-term changes in cardiorespiratory fitness and quality of life. Methods: Patients scheduled for open or endovascular AAA repair were previously randomized to either a 6-week preoperative SEP or standard management, and a significant improvement in a composite outcome of cardiac, pulmonary, and renal complications was seen following SEP. For the current analysis, patients were followed up to 5 years post-surgery. The primary outcome for this analysis was all-cause mortality. Data were analyzed on an intention to treat (ITT) and per protocol (PP) basis, with the latter meaning that patients randomized to SEP who did not attend any sessions were excluded. The PP analysis was further interrogated using a complier average causal effect (CACE) analysis on an all or nothing scale, which adjusts for compliance. Additionally, patients who agreed to follow-up attended the research center for cardiopulmonary exercise testing and/or provided quality of life measures. Results: ITT analysis demonstrated that the primary endpoint occurred in 24 of the 124 participants at 5 years, with eight in the SEP group and 16 in the control group (P =.08). The PP analysis demonstrated a significant survival benefit associated with SEP attendance (4 vs 16 deaths; P =.01). CACE analysis confirmed a significant intervention effect (hazard ratio, 0.36; 95% confidence interval, 0.16-0.90; P =.02). There was no difference between groups for cardiorespiratory fitness measures and most quality of life measures. Conclusions: These novel findings suggest a long-term mortality benefit for patients attending a SEP prior to elective AAA repair. The underlying mechanism remains unknown, and this merits further investigation.

Citation

Sethi, S., Ravindhran, B., Long, J., Gurung, R., Huang, C., Smith, G. E., …Pymer, S. (2024). A preoperative supervised exercise program potentially improves long-term survival after elective abdominal aortic aneurysm repair. Journal of vascular surgery, 79(1), 15-23. https://doi.org/10.1016/j.jvs.2023.09.004

Journal Article Type Conference Paper
Acceptance Date Sep 3, 2023
Online Publication Date Sep 14, 2023
Publication Date Jan 1, 2024
Deposit Date Jan 4, 2024
Publicly Available Date Jan 5, 2024
Journal Journal of Vascular Surgery
Print ISSN 0741-5214
Electronic ISSN 1097-6809
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 79
Issue 1
Pages 15-23
DOI https://doi.org/10.1016/j.jvs.2023.09.004
Keywords Abdominal aortic aneurysm; Supervised exercise therapy; Prehabilitation
Public URL https://hull-repository.worktribe.com/output/4459004

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