title: A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm.
abstract: BACKGROUND
  Several studies have compared outcomes after elective open and endovascular approaches to abdominal aortic aneurysm (AAA) surgery, with varying results.
  
  
  METHODS
  A random-effects meta-analysis was undertaken to compare operative outcomes, postoperative complications, 30-day mortality and long-term patient survival after surgery. Endpoints were compared using odds ratios (ORs), weighted mean differences (WMDs) or log hazard ratios (HRs) as appropriate.
  
  
  RESULTS
  Forty-two studies comprising 21,178 patients (10,855 open; 10,323 endovascular) were included. In the elective setting (20,715 patients), the endovascular method was associated with a shorter stay in intensive care (WMD--36 h; P < 0.001) and a shorter total postoperative stay (WMD--5.4 days; P < 0.001). Cardiac (OR 1.76; P = 0.002) and respiratory (OR 4.01; P < 0.001) complications were more common after open surgery. In the endovascular group, 30-day mortality was lower (OR 0.46; P < 0.001). Endovascular surgery was also associated with an improved long-term aneurysm-related mortality (HR 0.39; P < 0.001). For ruptured AAA (463 patients), the less invasive operation was associated with a reduced stay in intensive care (WMD--100.4 h; P = 0.005) and a significantly lower 30-day mortality (OR 0.45; P = 0.005).
  
  
  CONCLUSIONS
  The endovascular repair of AAA offers a clear benefit in terms of reduction in postoperative adverse events and 30-day mortality. In the longer term, it is also associated with a reduction in aneurysm-related mortality, but not in all-cause mortality.
authors.affiliation: Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK.
authors.forename: R E
authors.initials: RE
authors.lastname: Lovegrove
authors.forename: M
authors.initials: M
authors.lastname: Javid
authors.forename: T R
authors.initials: TR
authors.lastname: Magee
authors.forename: R B
authors.initials: RB
authors.lastname: Galland
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D002986:Clinical Trials as Topic; D017558:Elective Surgical Procedures / Q000379:methods; D004691:Endarterectomy / Q000379:methods*; D006801:Humans; D017594:Publication Bias; D016896:Treatment Outcome