1
|
Grima MJ, Boufi M, Law M, Jackson D, Stenson K, Patterson B, Loftus I, Thompson M, Karthikesalingam A, Holt P. Editor's Choice - The Implications of Non-compliance to Endovascular Aneurysm Repair Surveillance: A Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg 2018; 55:492-502. [PMID: 29307756 PMCID: PMC6481561 DOI: 10.1016/j.ejvs.2017.11.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 11/27/2017] [Indexed: 10/25/2022]
Abstract
OBJECTIVE/BACKGROUND Increasingly, reports show that compliance rates with endovascular aneurysm repair (EVAR) surveillance are often suboptimal. The aim of this study was to determine the safety implications of non-compliance with surveillance. METHODS The study was carried out according to the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was undertaken by two independent authors using Embase, MEDLINE, Cochrane, and Web of Science databases from 1990 to July 2017. Only studies that analysed infrarenal EVAR and had a definition of non-compliance described as weeks or months without imaging surveillance were analysed. Meta-analysis was carried out using the random-effects model and restricted maximum likelihood estimation. RESULTS Thirteen articles (40,730 patients) were eligible for systematic review; of these, seven studies (14,311 patients) were appropriate for comparative meta-analyses of mortality rates. Three studies (8316 patients) were eligible for the comparative meta-analyses of re-intervention rates after EVAR and four studies (12,995 patients) eligible for meta-analysis for abdominal aortic aneurysm related mortality (ARM). The estimated average non-compliance rate was 42.0% (95% confidence interval [CI] 28-56%). Although there is some evidence that non-compliant patients have better survival rates, there was no statistically significant difference in all cause mortality rates (year 1: odds ratio [OR] 5.77, 95% CI 0.74-45.14; year 3: OR 2.28, 95% CI 0.92-5.66; year 5: OR 1.81, 95% CI 0.88-3.74) and ARM (OR 1.47, 95% CI 0.99-2.19) between compliant and non-compliant patients in the first 5 years after EVAR. The re-intervention rate was statistically significantly higher in compliant patients from 3 to 5 years after EVAR (year 1: OR 6.36, 95% CI 0.23-172.73; year 3: OR 3.94, 85% CI 1.46-10.69; year 5: OR 5.34, 95% CI 1.87-15.29). CONCLUSION This systematic review and meta-analysis suggests that patients compliant with EVAR surveillance programmes may have an increased re-intervention rate but do not appear to have better survival rates than non-compliant patients.
Collapse
Affiliation(s)
- Matthew Joe Grima
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.
| | - Mourad Boufi
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Aix-Marseille Université, CNRS, IRPHE UMR 7342, Marseille, France; APHM, Department of Vascular Surgery, University Hospital Nord, Marseille, France
| | - Martin Law
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Dan Jackson
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Kate Stenson
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Benjamin Patterson
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Ian Loftus
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Matt Thompson
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Alan Karthikesalingam
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Peter Holt
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| |
Collapse
|
2
|
Albuquerque FC, Tonnessen BH, Noll RE, Cires G, Kim JK, Sternbergh WC. Paradigm shifts in the treatment of abdominal aortic aneurysm: Trends in 721 patients between 1996 and 2008. J Vasc Surg 2010; 51:1348-52; discussion 1352-3. [DOI: 10.1016/j.jvs.2010.01.078] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 01/12/2010] [Accepted: 01/25/2010] [Indexed: 11/25/2022]
|