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

Introduction A preoperative supervised exercise programme (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 five years post-surgery. The primary outcome for this analysis was all-cause mortality. Data were analysed on an intention to treat (ITT) and per protocol (PP) basis, with the latter meaning that patients randomised 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 centre for cardiopulmonary exercise testing and/or provided QoL measures. Results ITT analysis demonstrated that the primary endpoint occurred in 24 of the 124 participants at five years, with 8 in the SEP group and 16 in the control group (p = 0.08). The PP analysis demonstrated a significant survival benefit associated with SEP attendance (4 vs. 16 deaths p = 0.01). CACE analysis confirmed a significant intervention effect (HR = 0.36; 95% CI: 0.16, 0.90; p = 0.02). There was no difference between groups for cardiorespiratory fitness measures and most QoL measures. Conclusion 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.