A Preoperative Supervised Exercise Program Provides a 5-year Mortality Benefit for Patients Undergoing Abdominal Aortic Aneurysm Repair

Abstract

Supervised exercise prior to abdominal aortic aneurysm (AAA) repair reduces complications. The aim of this follow-up study was to identify if there was a survival benefit 5 years after surgery. We report on the long-term follow-up of a randomized controlled trial in which 124 patients undergoing AAA repair were randomized to a preoperative exercise program or control. All 124 patients were followed up, up to 5 years after surgery. Survival analysis was performed on an intention-to-treat and per-protocol basis using Kaplan-Meier curves and the log-rank test. Additional analysis was performed using compliance average causal effect analysis with compliance measured on an all or nothing scale. One hundred patients were still alive at 5 years after surgery. On intention-to-treat analysis, there were 16 deaths in the control group and 8 in the exercise group (P = .08). For per-protocol analysis, there were 16 deaths in the control group and 4 in the exercise group (P = .01). The compliance average causal effect analysis showed a significant intervention effect for compliers (hazard ratio, 0.36; P = .02). There is a long-term survival benefit for patients undergoing AAA repair who attend preoperative supervised exercise. We will reevaluate these patients via interview, cardiopulmonary exercise test and quality of life questionnaires, to establish what drives this benefit.