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Recovery after elective thoracic endovascular aortic repair : an exploratory study of patients' experiences

University of British Columbia

Thoracic endovascular aortic repair (TEVAR) is a highly specialized, and relatively uncommon surgical intervention to treat thoracic aortic disease (TAD) and prevent lethal aortic rupture. Current TEVAR research reports conventional clinical outcomes and lacks evidence of patient’s experiences. The aim of this work was to investigate the post-operative recovery experiences of patients who had undergone elective TEVAR and explore what patient factors were evident in their experiences of recovery and what perspectives can inform practitioners’ understanding of the recovery process. A qualitative interpretive description methodology guided the design, and the work focused on the recovery process occurring in hospital and after discharge. A clinical review of medical records of 106 elective TEVAR patients were analyzed, and 16 patients who had undergone elective TEVAR were interviewed, and data were analysed with descriptive statistics and content analysis. The clinical review showed patients who had TEVAR tended to be male, 70 years and older with significant comorbidities, and more than 90% experienced post-operative complications. Key themes of a serious, frightening event, vulnerability, an obscure, complex chronic illness and continuous uncertainty on an unrelenting journey emerged from the participant interviews. The major findings were that patients recovering from elective TEVAR have unique needs evidenced by the intricacies of various aortic pathologies, duration of hospital stay, and rate of post-operative complications. This patient population exhibits a significant level of chronicity evident from the physical and psychological challenges experienced during recovery in-hospital and at home. Additionally, patients who had elective TEVAR found themselves in a continuous cycle of transition. This study is unique because it brings the voices of patients and their experiences of recovery after elective TEVAR to the forefront, and the findings underscore the complexity and chronicity of TAD. This study also points to the need for more attention to aortic pathology, potential differences based on sex, and the need for increased attention to psychological aspects of recovery. Overall, the burden of recovery from TEVAR, continuous health maintenance and lifelong uncertainty experienced by patients emphasizes that elective TEVAR should be undertaken cautiously and only when adequate, holistic, multidisciplinary and life-long patient-centered supports are available.

Text

2020-12-11

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/76753

Nursing

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/