Sex as a Modifier of Health-Related Quality of Life, Illness Acceptance, and Psychological Distress in Patients After Aortic Aneurysm Repair: A 2-Year Prospective Study.

INTRODUCTION

Women constitute a minority of patients undergoing aortic aneurysm repair, yet available data suggest a worse quality of life and a higher burden of perioperative anxiety in this group. Prospective, multi-timepoint data comparing the sexes in Polish clinical centres are virtually absent. We assessed whether sex modifies quality of life, illness acceptance, and psychological distress over 2 years following aortic aneurysm repair.

MATERIAL AND

METHODS

In this prospective, single-centre cohort study, 150 consecutive patients (113 men, 37 women; mean age 69.9, SD 8.1 years) treated for aortic aneurysm between 2021 and 2024 completed the WHOQOL-Bref, the Acceptance of Illness Scale (AIS) and the Hospital Anxiety and Depression Scale, Polish modified version (HADS-M), immediately after surgery and at 6 months, 1 year and 2 years. The cohort was unrestricted with respect to aneurysm extent and repair modality. The primary analysis used generalised estimating equations including sex, time and the sex-by-time interaction, adjusted for age, repair modality, urgency of admission, ischaemic heart disease and partnered status. A prespecified sensitivity analysis was restricted to infrarenal aneurysms treated by standard endovascular repair (n=94).

RESULTS

Immediately after surgery, women scored lower than men in all four WHOQOL-Bref domains: physical 52.7 vs 60.2 (p=0.013), psychological 58.4 vs 68.1 (p=0.001), social relationships 59.0 vs 69.6 (p<0.001) and environmental 62.8 vs 67.5 (p=0.037); anxiety was higher in women (8.7 vs 7.1; p=0.035). After adjustment, the early deficit remained significant for the psychological domain (adjusted difference -9.26, 95% CI -15.54 to -2.98; p=0.004) and the social relationships domain (-9.85, 95% CI -15.95 to -3.74; p=0.002) but not for the physical or environmental domains, and the crude anxiety difference did not survive adjustment (p=0.253). Significant sex-by-time interactions indicated convergence in all domains except social relationships, for which the adjusted female deficit persisted across follow-up (-6.86, 95% CI -12.27 to -1.44; p=0.013). At 2 years no woman remained in the low illness-acceptance category compared with 20.5% of men (p=0.037); this categorical comparison rests on small and unstable cell counts and is presented as descriptive only. The sensitivity analysis reproduced and strengthened these findings.

CONCLUSION

Women undergoing aortic aneurysm repair report a lower quality of life in the early postoperative period, and the deficit in the social relationships domain is the one that persists over 2 years after adjustment. In the absence of a preoperative baseline and with a small female subgroup, these observations are hypothesis-generating and support the routine, sex-stratified capture of patient-reported outcome measures in aortic practice.