A meta-analysis of 21 178 patients undergoing open or endovascular repair of abdominal aortic aneurysm

Autor: Richard E Lovegrove, R.B. Galland, T.R. Magee, M. Javid
Rok vydání: 2008
Předmět:
Zdroj: British Journal of Surgery. 95:677-684
ISSN: 1365-2168
0007-1323
DOI: 10.1002/bjs.6240
Popis: Background Several studies have compared outcomes after elective open and endovascular approaches to abdominal aortic aneurysm (AAA) surgery, with varying results. Methods A random-effects meta-analysis was undertaken to compare operative outcomes, postoperative complications, 30-day mortality and long-term patient survival after surgery. Endpoints were compared using odds ratios (ORs), weighted mean differences (WMDs) or log hazard ratios (HRs) as appropriate. Results Forty-two studies comprising 21 178 patients (10 855 open; 10 323 endovascular) were included. In the elective setting (20 715 patients), the endovascular method was associated with a shorter stay in intensive care (WMD − 36 h; P < 0·001) and a shorter total postoperative stay (WMD − 5·4 days; P < 0·001). Cardiac (OR 1·76; P = 0·002) and respiratory (OR 4·01; P < 0·001) complications were more common after open surgery. In the endovascular group, 30-day mortality was lower (OR 0·46; P < 0·001). Endovascular surgery was also associated with an improved long-term aneurysm-related mortality (HR 0·39; P < 0·001). For ruptured AAA (463 patients), the less invasive operation was associated with a reduced stay in intensive care (WMD − 100·4 h; P = 0·005) and a significantly lower 30-day mortality (OR 0·45; P = 0·005). Conclusions The endovascular repair of AAA offers a clear benefit in terms of reduction in postoperative adverse events and 30-day mortality. In the longer term, it is also associated with a reduction in aneurysm-related mortality, but not in all-cause mortality.
Databáze: OpenAIRE
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