title: A meta-analysis and metaregression analysis of factors influencing mortality after endovascular repair of ruptured abdominal aortic aneurysms.
abstract: OBJECTIVE
  To determine factors that may influence the perioperative mortality after endovascular repair of ruptured abdominal aortic aneurysms (RAAAs) using metaregression analysis.
  
  
  METHODS
  A meta-analysis of all English-language literature with information on mortality rates after endovascular repair of RAAAs was conducted. A metaregression was subsequently performed to determine the impact on mortality of the following 8 factors: patient age; mid-time study point; anaesthesia; endograft configuration; haemodynamic instability; use of aortic balloon; conversion to open repair; and abdominal compartment syndrome.
  
  
  RESULTS
  The pooled perioperative mortality across the 46 studies (1397 patients) was 24.3% (95% CI: 20.7-28.3%). Of the 8 variables, only bifurcated approach was significantly associated with reduced mortality (p = 0.005). A moderate negative correlation was observed between bifurcated approach and haemodynamic instability (-0.35). There was still a strong association between bifurcated approach and mortality after simultaneously adjusting for haemodynamic instability, indicating that the latter was not a major factor in explaining the observed association.
  
  
  CONCLUSIONS
  Endovascular repair of RAAAs is associated with acceptable mortality rates. Patients having a bifurcated endograft were less likely to die. This may be due to some surgeons opting for a bifurcated approach in patients with better haemodynamic condition. Further studies will be needed to clarify this.
authors: The 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Greece. ckarkos@hotmail.com
authors: C D
authors: CD
authors: Karkos
authors: A J
authors: AJ
authors: Sutton
authors: M J
authors: MJ
authors: Bown
authors: R D
authors: RD
authors: Sayers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000401:mortality*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000628:therapy*; D001019:Aortic Rupture / Q000401:mortality* / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000401:mortality; D008297:Male; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors