From innumeracy to insight: the uncertainty of help versus harm in treatment of asymptomatic aortic aneurysms.
There is insufficient evidence that the surgical treatment of asymptomatic infrarenal aneurysms > 5.5 cm. is beneficial to patients. This is the result of serious complications of aneurysm surgery and the dearth of information from randomized trials. Based on evidence from the literature we defined scenarios and translated data into natural frequency trees to improve understanding of the uncertainty of help versus harm due to treatment of aneurysms. Our analysis shows that the majority of patients can expect little on longevity from surgery while they are at risk of dying from surgery or suffering from serious morbidity. We conclude that, as long as uncertainty persist, patients should be treated in hospitals that can show very low surgical mortality and major morbidity rates. To further resolve the problem of uncertainty randomized trials for larger aneurysms should be performed. Important issues to discuss are the lower and upper limits of the diameter of the aneurysms and the age and risk profiles of the patients to be included in such trials.
Legemate
D A
DA
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. d.a.legemate@amc.nl
Bossuyt
P M
PM
D001014:Aortic Aneurysm / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000517:prevention & control*; D003627:Data Interpretation, Statistical; D003663:Decision Trees; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D015233:Models, Statistical; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D035501:Uncertainty; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality