Quality of life (QOL) after surviving a RAAA is still controversial. Many authors reported changes in QOL but there is still a lack of true evidence as far as other papers showed that QOL after surgery for RAAA is the same as the general population. In this retrospective review we aimed to study two endpoints; the primary endpoint was to confirm if there is a true change in QOL, and the secondary endpoint was to evaluate if there are some clinical or biological factors in the pre operative or post operative period that can interfere in the real outcome for these patients.

Between 2011 and mid 2017, and among 117 patients operated for AAA, 31 patients presented for a ruptured AAA and were operated by open surgery. The mean age was 67 years old, the male over female ratio was 24/7, all patients (100%) were hypertensive, almost 40% (13) were diabetic, and upon presentation all had severe lumbar or abdominal pain, and 61% (19) were hypotensive (blood pressure varied between 90/50mmhg and 70/40mmhg). The mean operating time was around 150 min, the ICU stay varied between 3 and 8 days, the hospital stay varied between 7 and 23 days and the average of blood transfusion was around 5 units per patient. All patients survived the operation. 5 patients died in the post operative period (2 from myocardial infarction, 1 from a peritonitis due to a perforated ischemic colitis, and 2 from severe pneumonia). And 1 patient died after 13 months from massive ischemic CVA. Retrospectively, patients were called with a close family member to a follow up and to fill both separately a questionnaire (WHO-QOL) about their quality of life and both results were compared.

If taking only the results filled by the patients, only 3 reported a change in their QOL, but when looking in the answers of the close family members, 15/25 reported major changes in QOL and changes in their behavior by developing like post traumatic disorders, and the results were as it follows: 4 patients did not resume their work until 8 months post operatively because they were afraid to drive a car, 2 patients developed severe OCD (one was doing a CT scan of the abdomen every month, and one was going to the ER for every abdominal pain felt), 7 patients developed like moderate depression and never went out until 4 months post operatively and still have severe anxiety disorders, and 2 patients had severe depression and lost their work definitively. And by going into further details to find a true biological or clinical associated factor we found the following: 100% were male, 60% were diabetic, 73% were hypotensive, 53% had an ICU stay more than 3 days, 87% were less than 70 years old and finally 67% had upon presentation hemoglobin less than 10g/dl.

Despite many controversies concerning the quality of life in patients operated for RAAA, we found that this kind of surgery is very traumatic and had severe repercussions on the psychological and social outcome to almost 60% of patients who survive the rupture and this can be due to the pathology by itself, the operation, and of course many factors (Male gender, age, diabetes, prolonged ICU stay, hypotension on presentation ….) that can be correlated to the final outcome. This is why we propose a close follow up by a group of specialist (Psychiatrist, psychologist, social counseling ….) to avoid the post operative traumatic disorders. And of course a much larger study is needed to confirm those results and to emerge clear and definitive data concerning the QOL in patients who survive a RAAA.