Elective Open Repair of AbdominalAortic Aneurysms (AAA):
A Systematic Review of Risk Factorsfor Associated Mortality
Dezembro 2007
Turma 5 - 1º ano Mestrado Integrado em Medicina, FMUP
Outline
Topics
•Introduction
•Research Question and Aims
•Participants and Methods
–Type of Study
–Study Participants
–Study Design
–Variables and data collection
–Statistical Analysis
–Expected Results
•Current Situation
•Future Work
INTRODUCTION
Abdominal Aortic Aneurysm (AAA):
Abnormal widening of artery, usuallyconsidered when the widening is morethan 1.5 times the “normal” diameterof the aorta above
What is an AAA?
INTRODUCTION
What is an AAA?
Risk Factors:
•Smoking
•Family history of AAA
•Chronic obstructive pulmonary disease
•Previous vascular surgery
•Hypertension
•Atherosclerosis
•Age>50 y.o. and male gender
INTRODUCTION
What are the risk factors for AAA development?
INTRODUCTION
Elective Open Repair (EOR):
•Invasive surgery procedure withinsertion of a prosthetic tube-likegraft
•Two types:
–Transperitoneal
–Left retroperitoneal
What is an EOR?
INTRODUCTION
Postoperative Complications:
•Haemorrhage
•Gastrointestinal ischemia and/or dysfunction
•Cardiac events
•Pulmonary insufficiency
•Renal failure
•Erectile dysfunction
•Graft infection
What are the common postoperative complications of EOR?
RESEARCH QUESTION AND AIMS
Research Questions:
•Which risk factors and postoperative complicationsmostly contribute to mortality after EOR?
•Is it possible to improve the prediction of patient’soutcome after EOR?
Aims:
•Summarize mortality rates and Identify risk factors andpostoperative complications which are more commonlyassociated with mortality after EOR.
Research Question and Aims
Type of Study
Systematic Review
Type of Study
PARTICIPANTS AND METHODS
Study Participants (n=203)
All published papers on PubMed Database considering aquery with the words:
•(("abdominal aortic aneurysm"[Text Word] OR "aortic aneurysm,abdominal"[MeSH Terms] OR aaa[Text Word])
•AND elective[All Fields]
•AND open[All Fields])
•AND ((("wound healing"[TIAB] NOT Medline[SB]) OR "wound healing“[MeSHTerms] OR repair[Text Word]) OR ("surgery"[Subheading] OR "operativesurgical procedures"[Text Word] OR "surgical procedures, operative"[MeSHTerms] OR "surgery"[MeSH Terms] OR surgery[Text Word]))
•AND mortality[Text Word]
Study Participants
PARTICIPANTS AND METHODS
Study Design:
1st Triage Phase
PARTICIPANTS AND METHODS
n=80
Study Design
Study Design: 1st Triage Phase
•Inclusion Criteria
1.Abdominal aortic aneurysms (AAA)
2.Elective open repair/surgery (EOR)
3.Mortality rates after elective open repair
4.Postoperative complications
5.Patient’s outcome
•Exclusion Criteria
1.Other types or “mixed” aortic aneurysms (n=10)
2.Emergency repair of ruptured AAA (n=13)
3.Patients submitted to endovascular repair (EVAR) (n=51)
4.Other papers as reviews, systematic reviews, meta-analysis, letters or editorials (n=20)
5.Papers in other languages rather than English, French, Spanish or Portuguese (n=16)
6.Not related studies (n=26)
PARTICIPANTS AND METHODS
Study Design
Study Design:
2nd Triage Phase
PARTICIPANTS AND METHODS
Included papersn=80
Study Design
Study Design: 2nd Triage Phase
PARTICIPANTS AND METHODS
The inclusion criteria will be the availability of information for each ofthe predefined variable in study.
Study Design
Study Design:
Final Phase
PARTICIPANTS AND METHODS
Full papers includedn=??
Study Design
Variable description and data collection:
Article peer-review to extract information data about :
Study characteristics:
•name of first author
•year of publication
•country of origin
•type of study
•sample size
Preoperative clinical variables:
•age
•risk factors exposition
•patient’s condition
•aneurysm diameter
Postoperative Clinical variables:
venous bleeding
gastrointestinal ischemia
renal failure
myocardial infarction
respiratory complications
clinical outcome <30 days
PARTICIPANTS AND METHODS
Variables in study
Planed statistical analysis
•Data input on Database using Statistical Package for Social Sciences(SPSS) or Review Manager (RevMan) software
•Analysis of the frequency of each factor/complication
•Selection of the most common postoperative complications
•Estimation of Relative Risk (RR) of each factor for mortality
•Comparison of mortality rates with clinical and outcome history
PARTICIPANTS AND METHODS
Statistical Analysis
Limits of the study
We are aware that the Query we have applied may not be specificenough due to:
1.Inexistence of a unique term to define “elective open repair”
2.The number of risk factors and postoperative complications
3.Difficulty to define the outcome<30 days after repair
Limits
RESULTS
Expected Results
•Summarize the mortality rates and Identify the postoperativecomplications more commonly associated with failure after EOR
•Provide “strong” evidences for prediction of patient’s outcome afterEOR based on the clinical evidences and postoperative complications
Expected Results
RESULTS
Current situation
CURRENT SITUATION
Gant Map (Phase 1 and 2)
FUTURE WORK
FUTURE WORK
Gant Map (Phase 3 and 4)
Elective Open Repair of AbdominalAortic Aneurysms (AAA):
A Systematic Review of Risk Factorsfor Associated Mortality
Dezembro 2007
Turma 5 - 1º ano Mestrado Integrado em Medicina, FMUP