Background: the UK Small Aneurysm Trial was established to test the benefit of prophylactic elective surgery for small abdominal aortic aneurysms (4.0-5.5 cm in diameter) and identify prognostic risk factors, including smoking.Patients, methods and outcomes: one thousand and ninety patients (902 men and 188 women, mean age 69.3 years) were randomised to either early elective surgery or ultrasonography surveillance until the aneurysm diameter exceeded 5.5 cm, mean follow-up was 4.6 years. Baseline assessments included lung function tests and continue (a smoking marker). The principal outcome measures were all-cause mortality and aneurysm rupture.Results: during the course of the trial, aneurysm rupture was diagnosed in 25 patients and 309 patients died. Whereas self-reported smoking status was not significantly associated with survival, patients without any trace of plasma cotinine had a significantly improved long-term (6-year) survival, p = 0.02. Current smokers had a lower FEV1 than post- and never-smokers. FEV1 was the most powerful predictor of long-term (6-year) survival, the crude death rates per 100 person-years were 9.1, 6.9 and 4.6 for those with FEV1 <1.91, 1.9-2.51 and >2.51 respectively, p = 0.001. Moreover, the rupture rate was 1.9% per year for patients positive for plasma cotinine compared with 0.5% in those without trace of plasma cotinine, p = 0.004.Conclusions: self-reported smoking status underestimates the effect of continued smoking on the prognosis of patients with small abdominal aortic aneurysm. Patients with high plasma cotinine concentrations (smokers) have an increased risk of aneurysm rupture and poorer long-term survival.

Objectives: To investigate factors associated with a prolonged hospital stay after elective open surgical repair of abdominal aortic aneurysm.Patients and methods: We have investigated prospectively base-line risk factors associated with an increased length of postoperative hospital stay in 474 of the patients undergoing surgery as part of the U.K. Small Aneurysm Trial.Results: The median length of hospital stay was 11 days (interquartile range 9-14 days). Age (within the range 60-76 years), sex, body mass index, aneurysm diameter, graft type (tube ol bifurcated), hospital (university or other), ECG characteristics, angina (from Rose questionnaire) and/or previous myocardial infarction were not associated with length of hospital stay. Quality of life also teas assessed before surgery using the Medical Outcomes Study SF20. Psychosocial aspects including level of social functioning, role functioning, mental health, health perceptions and pain were not associated with length of postoperative stay. The level of preoperative physical functioning was associated inversely with length of hospital stay, p = 0.004. Patients' length of hospital stay also was inversely associated with preoperative lung function: FEV,, p = 0.011 and FVC, p = 0.006. In contrast, smoking habit was of only borderline significance, p = 0.09.Conclusion: Conditional logistic regression analysis identified only preoperative lung function (FEV1 and FVC) and physical functioning, three intrinsically linked factors, as predictors of length of hospital stay after elective repair of an abdominal aortic aneurysm.

Objectives: To study the outcome of surgery versus ultrasound surveillance for small aortic aneurysms.Design: Multicentre, random allocation, open trial.Setting: University and general hospitals across the UK.Materials: Patients aged 60-76 years with small asymptomatic abdominal aortic aneurysms (4-5.5 cm in diameter).Chief Outcome Measures: The mortality rate, costs, usage of health service resources and quality of life of each treatment will be compared.Conclusions: From patients randomised to ultrasound surveillance, the natural history of small aneurysms will be determined. The design, methods and progress of this trial are reported here.