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Title: Addressing the poor life expectancy that persists despite surviving abdominal aortic aneurysm repair
Author: Bahia, Sandeep Singh
ISNI:       0000 0004 7962 523X
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2017
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Background: Improved critical care, better preoperative optimisation and the advent of endovascular surgery (EVAR) have dramatically reduced 30-day mortality for elective abdominal aortic aneurysm (AAA) repair. However, it remains unknown whether this has translated into improvements in life expectancy and 5-year survival after surgery. Methods: This thesis explores the long-term survival of patients undergoing elective aneurysm surgery, both from contemporary datasets as well as retrospectively analysing survival trends over time, and goes on to develop and implement a prospective intervention aimed at improving long-term survival. Results: A systematic literature review demonstrates that long-term survival after AAA remains poor, with a survival estimate of only 69% at 5-years. Further analyses support the assertion that patients with aortic aneurysms have significantly poorer life expectancy than patients without aneurysms, even when matched for social deprivation and place and date of surgery. Subsequent analyses of British primary care data demonstrate that AAA patients prescribed appropriate medications live longer, but that not all patients with AAA are receiving them. A further retrospective analysis of echocardiographic data for patients undergoing AAA repair shows that we can predict those patients most likely to die within 5-years of their AAA surgery. Conclusion: This thesis identifies that long-term survival remains poor in patients with AAA and that prescribing of drugs that could improve their survival is also poor. Cardiac Rehabilitation (CR) is identified as a potential intervention to improve survival after AAA surgery and a pilot prospective randomised controlled trial has been developed and implemented.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available