This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
A meta‐analysis of 21 178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. BJS 2008; 95: 677-684.
Published: 29th April 2008
Authors: R. E. Lovegrove, M. Javid, T. R. Magee, R. B. Galland
Background
Several studies have compared outcomes after elective open and endovascular approaches to abdominal aortic aneurysm (AAA) surgery, with varying results.
Method
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).