Elective Open Repair of Abdominal Aortic Aneurysms (AAA):

1. Elective Open Repair of Abdominal Aortic Aneurysms (AAA): A Systematic Review of Risk Factors for Associated Mortality Dezembro 2007 Turma 5 - 1º ano Mestrado Integrado em Medicina, FMUP

2. 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

3. INTRODUCTION Abdominal Aortic Aneurysm (AAA): Abnormal widening of artery, usually considered when the widening is more than 1.5 times the “normal” diameter of the aorta above What is an AAA?

4. INTRODUCTION What is an AAA?

5. INTRODUCTION • Risk Factors: • Smoking • Family history of AAA • Chronic obstructive pulmonary disease • Previous vascular surgery • Hypertension • Atherosclerosis • Age>50 y.o. and male gender What are the risk factors for AAA development?

6. INTRODUCTION • Elective Open Repair (EOR): • Invasive surgery procedure with insertion of a prosthetic tube-like graft • Two types: • Transperitoneal • Left retroperitoneal What is an EOR?

7. 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?

8. RESEARCH QUESTION AND AIMS Research Questions: • Which risk factors and postoperative complications mostly contribute to mortality after EOR? • Is it possible to improve the prediction of patient’s outcome after EOR? Aims: • Summarize mortality rates and Identify risk factors and postoperative complications which are more commonly associated with mortality after EOR. Research Question and Aims

9. PARTICIPANTS AND METHODS Type of Study Systematic Review Type of Study

10. PARTICIPANTS AND METHODS Study Participants (n=203) All published papers on PubMed Database considering a query 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“[MeSH Terms] OR repair[Text Word]) OR ("surgery"[Subheading] OR "operative surgical procedures"[Text Word] OR "surgical procedures, operative"[MeSH Terms] OR "surgery"[MeSH Terms] OR surgery[Text Word])) • AND mortality[Text Word] Study Participants

11. PARTICIPANTS AND METHODS Study Design: 1st Triage Phase n=80 Study Design

12. PARTICIPANTS AND METHODS Study Design: 1st Triage Phase • Inclusion Criteria • Abdominal aortic aneurysms (AAA) • Elective open repair/surgery (EOR) • Mortality rates after elective open repair • Postoperative complications • Patient’s outcome • Exclusion Criteria • Other types or “mixed” aortic aneurysms (n=10) • Emergency repair of ruptured AAA (n=13) • Patients submitted to endovascular repair (EVAR) (n=51) • Other papers as reviews, systematic reviews, meta-analysis, letters or editorials (n=20) • Papers in other languages rather than English, French, Spanish or Portuguese (n=16) • Not related studies (n=26) Study Design

14. PARTICIPANTS AND METHODS Study Design: 2nd Triage Phase Included papersn=80 Study Design

15. PARTICIPANTS AND METHODS Study Design: 2nd Triage Phase The inclusion criteria will be the availability of information for each of the predefined variable in study. Study Design

16. PARTICIPANTS AND METHODS Study Design: Final Phase Full papers includedn=?? Study Design

17. PARTICIPANTS AND METHODS • 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 Variables in study

18. PARTICIPANTS AND METHODS • 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 Statistical Analysis

19. RESULTS Limits of the study We are aware that the Query we have applied may not be specific enough due to: • Inexistence of a unique term to define “elective open repair” • The number of risk factors and postoperative complications • Difficulty to define the outcome<30 days after repair Limits

20. RESULTS • Expected Results • Summarize the mortality rates and Identify the postoperative complications more commonly associated with failure after EOR • Provide “strong” evidences for prediction of patient’s outcome after EOR based on the clinical evidences and postoperative complications Expected Results

21. Current situation

22. CURRENT SITUATION Gant Map (Phase 1 and 2)

23. FUTURE WORK

24. FUTURE WORK Gant Map (Phase 3 and 4)

25. Elective Open Repair of Abdominal Aortic Aneurysms (AAA): A Systematic Review of Risk Factors for Associated Mortality Dezembro 2007 Turma 5 - 1º ano Mestrado Integrado em Medicina, FMUP