Early Quality of Recovery After Endovascular Versus Open Abdominal Aortic Aneurysm Repair.

INTRODUCTION: To compare early postoperative quality of recovery after endovascular (EVAR) versus open (OSR) repair for infrarenal abdominal aortic aneurysm (AAA) using the Quality of Recovery-15 (QoR-15) questionnaire, interpreting between-group differences against the published minimal clinically important difference (MCID) for this instrument. METHODS: All patients undergoing elective EVAR or OSR between January 2023 and January 2025 were prospectively enrolled. QoR-15 was recorded at baseline, hospital discharge, and one month, and analyzed with a linear mixed-effects model (group, time, and their interaction; random intercept per patient). Because the groups differed at baseline in several characteristics, a second, covariate-adjusted model added age, ASA class ≥3, history of ischemic heart disease, peripheral arterial disease, and hypertension as fixed effects. RESULTS: A total of 141 patients were analyzed (EVAR n = 62, OSR n = 79). Thirty-day mortality was 1.6% in the EVAR group and 0% in the OSR group. QoR-15 scores changed significantly over time (p < .001) and were higher overall in the EVAR group (p = .016). At discharge, the between-group difference was 10 points favoring EVAR (p = .001), exceeding the published MCID of 8 points and supporting clinical as well as statistical significance. This advantage was absent at baseline (2 points; p = .332) and at one month (4 points; p = .135), both below the MCID. After adjustment for age, ASA class, ischemic heart disease, peripheral arterial disease, and hypertension, the discharge difference remained unchanged (10.0 points, 95% CI 1.6-18.4; p = .020), and the averaged group effect stayed significant (F (1,131) = 4.60; p = .034). The group × time interaction was non-significant in both models (unadjusted p = .052; adjusted p = .101). CONCLUSIONS: EVAR was associated with a discharge-time advantage in patient-reported recovery that exceeded the MCID for QoR-15, and this advantage persisted after covariate adjustment but resolved by one month. These findings support patient-reported recovery as a clinically meaningful complementary outcome after AAA repair, although the non-randomized design warrants confirmation in a larger study.