Improving patient-centered outcomes after open and minimally invasive abdominal aortic aneurysm repair

Currently, scientific literature on outcomes after abdominal aortic aneurysm repair is focused heavily on the technical outcomes of surgery like rates of death, complications and reinterventions.

Samir K. Shah, M.D., assistant professor in the division of vascular surgery and endovascular therapy at the University of Florida, would like to add another measure of success.

“When patients are making decisions about their treatment plans, they are interested in things like pain after procedure, the ability to move around and to continue to live independently,” Shah said. “And those really haven’t been measured in any meaningful way on a longitudinal basis.”

Traditionally, one method of measuring such outcomes is using “paper and pencil” surveys. The most basic way, Shah explains, is to simply ask patients what their highest level of pain has been when they return for follow-up visits in clinic. The problem with this approach, however, is that human recall accuracy can vary and is known to be biased.

One way to minimize this human error is to use a technique called ecological momentary analysis, which involves asking patients about their experience in the moment, Shah said. In the past, this has been done by giving patients journals and sometimes pagers to remind them to write down their experiences throughout the day.

“Nowadays, we can also use phones to remind them to check in with themselves, and go document their pain levels or how they’re feeling in the moment,” Shah said. “But those actions can still prove burdensome to patients.”

Enter ROAMM (Real-time Online Assessment and Mobility Monitor), a straightforward, user-friendly platform designed by a veritable smorgasbord of various faculty members ranging from the UF Aging Institute to the UF College of Engineering. ROAMM includes an application that loaded onto an Apple Watch® and given to patients prior to surgery. At intermittent points throughout the day, watches will prompt patients to record their level of pain at that moment in time, their mood, while passively recording steps and other measures of mobility.

“Even receiving data on how far they’ve been able to walk can provide us with a means to quantify mobility in a very granular way,” Shah said. “The idea is, this project will show that it is actually quite feasible to measure these things using advanced technology in an older patient population, despite worries that they will feel less comfortable with newer technology.”

For a procedure that is typically preventative and elective, ensuring patients have all the information they can is paramount to an informed decision, Shah explained.

Eventually, Shah said, the goal is to apply it on a repeated, standard basis as part of preoperative consultations. One day, he hopes to be able to see a patient who is in clinic for an elective procedure for an aortic aneurysm and provide a comprehensive, transparent overview of not only the technical outcomes and serious risks, but also when they can expect to return to life as they know it.

“As physicians, we want to see alignment between what the patient wants and what we can provide,” Shah said. “So instead of treating people’s conditions, we’re trying to see them as people who happen to have aneurysms instead of just treating their aneurysms.”