Improving outcomes in abdominal aortic aneurysm patients
File(s)
Author(s)
Rawashdeh, Majd
Type
Thesis
Abstract
Background
Patients undergoing abdominal aortic aneurysm repair suffer from multiple comorbidities and frailty. Perioperative and postoperative complications are common following AAA repair, and research should be undertaken to improve overall outcomes. Preoperative exercise therapy (Prehabilitation) is a well-described method for improving surgical outcomes; however, it is uncertain if patients scheduled for AAA repair would benefit from prehabilitation. The goal of this thesis is to provide new evidence for prehabilitation in AAA patients awaiting surgery and explore the feasibility of using a novel adjunct to facilitate rehabilitation following surgery.
Methods
This thesis is mainly made up of three main studies. Analysis of National Vascular Registry data to highlight the impact of frailty on patients undergoing AAA repair. A proof-of-concept feasibility study assessing a novel 6-week remote prehabilitation programme for patients scheduled for AAA repair. A pilot randomised controlled study aimed at improving rehabilitation of general and vascular surgery patients using a neuromuscular electrical stimulation device.
Results
The first study highlighted the negative impact of frailty status on short-term outcomes following AAA repair, with a significantly increased risk of combined cardiovascular and mortality events in patients undergoing open AAA repair. A 6-week remote prehabilitation programme for AAA patients scheduled repair is feasible and improves functional capacity. Introducing a neuromuscular electrical stimulation device as an adjunct to rehabilitation for general and vascular patients is acceptable and safe.
Conclusion
Frailty is associated with worse outcomes for patients undergoing repair. Remote prehabilitation of AAA patients is feasible and can potentially improve outcomes following repair. The use of NMES as an adjunct to rehabilitation has the potential to enhance recovery following surgery and should be further explored. This thesis provided new evidence to support a national multicentre study to investigate novel interventions aimed at improving outcomes of AAA patients.
Patients undergoing abdominal aortic aneurysm repair suffer from multiple comorbidities and frailty. Perioperative and postoperative complications are common following AAA repair, and research should be undertaken to improve overall outcomes. Preoperative exercise therapy (Prehabilitation) is a well-described method for improving surgical outcomes; however, it is uncertain if patients scheduled for AAA repair would benefit from prehabilitation. The goal of this thesis is to provide new evidence for prehabilitation in AAA patients awaiting surgery and explore the feasibility of using a novel adjunct to facilitate rehabilitation following surgery.
Methods
This thesis is mainly made up of three main studies. Analysis of National Vascular Registry data to highlight the impact of frailty on patients undergoing AAA repair. A proof-of-concept feasibility study assessing a novel 6-week remote prehabilitation programme for patients scheduled for AAA repair. A pilot randomised controlled study aimed at improving rehabilitation of general and vascular surgery patients using a neuromuscular electrical stimulation device.
Results
The first study highlighted the negative impact of frailty status on short-term outcomes following AAA repair, with a significantly increased risk of combined cardiovascular and mortality events in patients undergoing open AAA repair. A 6-week remote prehabilitation programme for AAA patients scheduled repair is feasible and improves functional capacity. Introducing a neuromuscular electrical stimulation device as an adjunct to rehabilitation for general and vascular patients is acceptable and safe.
Conclusion
Frailty is associated with worse outcomes for patients undergoing repair. Remote prehabilitation of AAA patients is feasible and can potentially improve outcomes following repair. The use of NMES as an adjunct to rehabilitation has the potential to enhance recovery following surgery and should be further explored. This thesis provided new evidence to support a national multicentre study to investigate novel interventions aimed at improving outcomes of AAA patients.
Version
Open Access
Date Issued
2024-11-28
Date Awarded
01/08/2025
License URL
Advisor
Davies, Alun H
Lane, Tristan RA
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)