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Patient fitness and survival after abdominal aortic aneurysm repair in patients from the UK EVAR trials.
- Source :
-
British Journal of Surgery . Jun2007, Vol. 94 Issue 6, p709-716. 8p. 1 Diagram, 4 Charts, 2 Graphs. - Publication Year :
- 2007
-
Abstract
- Background: The aim was to use a validated fitness score to determine whether fitter patients with a large abdominal aortic aneurysm (AAA) benefited from having open rather than endovascular repair. Methods: The Customized Probability Index (CPI) was applied to patients in the Endovascular Aneurysm Repair (EVAR) I and II trials. Interaction tests between CPI and randomized group assessed the effect of fitness and type of AAA repair on elective 30-day mortality and 4-year survival. Results: The mean(s.d.) CPI scores were 3.6(9.3) for 1252 EVAR I patients and 10.0(11.3) for 404 EVAR II patients (range -25 to +43) (P < 0-001). The fitness of EVAR I patients was classified as good (579 patients, mean CPI -4.2), moderate (331 patients, mean CPI 5.7) or poor (338 patients, mean CPI 15.1). Only in the good fitness group did 30-day mortality convincingly favour endovascular repair (odds ratio 0.24, P = 0.030), but overall the test of interaction was not significant (P = 0.363). For 4-year all-cause and aneurysm-related mortality, there was no benefit for either treatment across all fitness scores (P = 0.281 and P = 0.371 respectively). Conclusion: The benefit of endovascular repair was most convincing in the fittest patients. There was no evidence that the fittest patients benefited more from open surgery. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00071323
- Volume :
- 94
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- British Journal of Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 25529440
- Full Text :
- https://doi.org/10.1002/bjs.5776