Meta-analysis of postoperative mortality after elective repair of abdominal aortic aneurysms detected by screening.

Abstract

The aim of this study was to compare the mortality rate within 30 days of elective surgery for abdominal aortic aneurysm (AAA) in men randomized to an invitation for ultrasound screening with that of men in the control group, whose aneurysms were detected incidentally. Relevant reports from randomized trials of screening were identified through a systematic search of MEDLINE. Four relevant trials were identified, and supplemented with data from the Viborg Vascular screening trial. Data were updated in two studies. Meta-analysis was undertaken with effects calculated as a fixed odds ratio (OR) with 95 per cent confidence interval. Heterogeneity between the studies was assessed by the χ(2) test. There were 25 deaths (2·9 per cent) following elective surgery in 858 men invited for screening compared with 21 (5·5 per cent) of 383 in the control group (OR 0·49, 0·27 to 0·88). There were 18 deaths (2·4 per cent) following elective surgery for 747 screen-detected AAAs compared with 28 (6·1 per cent) following elective repair of 459 incidentally detected aneurysms (OR 0·37, 0·20 to 0·68). The offer of screening identifies men whose early survival following elective AAA repair is better than that of men with an AAA detected incidentally.