elective open repair of abdominal aortic aneurysms (aaa):
DESCRIPTION
Elective Open Repair of Abdominal Aortic Aneurysms (AAA): A Systematic Review of Risk Factors for Associated Mortality. Dezembro 2007. Turma 5 - 1º ano Mestrado Integrado em Medicina, FMUP. Outline. Topics Introduction Research Question and Aims Participants and Methods Type of Study - PowerPoint PPT PresentationTRANSCRIPT
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Elective Open Repair of Abdominal Aortic Aneurysms (AAA):
A Systematic Review of Risk Factors for Associated Mortality
Dezembro 2007
Turma 5 - 1º ano Mestrado Integrado em Medicina, FMUP
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Outline
Topics• Introduction• Research Question and Aims• Participants and Methods
– Type of Study– Study Participants– Study Design– Variables and data collection– Statistical Analysis– Expected Results
• Current Situation• Future Work
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INTRODUCTION
Abdominal Aortic Aneurysm (AAA):
Abnormal widening of artery, usually considered when the widening is more than 1.5 times the “normal” diameter of the aorta above
What is an AAA?
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INTRODUCTION
What is an AAA?
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Risk Factors:
• Smoking
• Family history of AAA
• Chronic obstructive pulmonary disease
• Previous vascular surgery
• Hypertension
• Atherosclerosis
• Age>50 y.o. and male gender
INTRODUCTION
What are the risk factors for AAA development?
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INTRODUCTION
Elective Open Repair (EOR):
• Invasive surgery procedure with insertion of a prosthetic tube-like graft
• Two types:– Transperitoneal
– Left retroperitoneal
What is an EOR?
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INTRODUCTION
Postoperative Complications:• Haemorrhage• Gastrointestinal ischemia and/or dysfunction• Cardiac events• Pulmonary insufficiency• Renal failure• Erectile dysfunction• Graft infection
What are the common postoperative complications of EOR?
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RESEARCH QUESTION AND AIMS
Research Questions:
• Which risk factors and postoperative complications mostly contribute to mortality after EOR?
• Is it possible to improve the prediction of patient’s outcome after EOR?
Aims:• Summarize mortality rates and Identify risk factors and
postoperative complications which are more commonly associated with mortality after EOR.
Research Question and Aims
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Type of Study
Systematic Review
Type of Study
PARTICIPANTS AND METHODS
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Study Participants (n=203)All published papers on PubMed Database considering a
query with the words:• (("abdominal aortic aneurysm"[Text Word] OR "aortic aneurysm,
abdominal"[MeSH Terms] OR aaa[Text Word])
• AND elective[All Fields]
• AND open[All Fields])
• AND ((("wound healing"[TIAB] NOT Medline[SB]) OR "wound healing“[MeSH Terms] OR repair[Text Word]) OR ("surgery"[Subheading] OR "operative surgical procedures"[Text Word] OR "surgical procedures, operative"[MeSH Terms] OR "surgery"[MeSH Terms] OR surgery[Text Word]))
• AND mortality[Text Word]
Study Participants
PARTICIPANTS AND METHODS
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Study Design:1st Triage Phase
PARTICIPANTS AND METHODS
n=80
Study Design
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Study Design: 1st Triage Phase
• Inclusion Criteria1. Abdominal aortic aneurysms (AAA)
2. Elective open repair/surgery (EOR)
3. Mortality rates after elective open repair
4. Postoperative complications
5. Patient’s outcome
• Exclusion Criteria1. Other types or “mixed” aortic aneurysms (n=10)
2. Emergency repair of ruptured AAA (n=13)
3. Patients submitted to endovascular repair (EVAR) (n=51)
4. Other papers as reviews, systematic reviews, meta-analysis, letters or editorials (n=20)
5. Papers in other languages rather than English, French, Spanish or Portuguese (n=16)
6. Not related studies (n=26)
PARTICIPANTS AND METHODS
Study Design
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Study Design:2nd Triage Phase
PARTICIPANTS AND METHODS
Included papersn=80
Study Design
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Study Design: 2nd Triage Phase
PARTICIPANTS AND METHODS
The inclusion criteria will be the availability of information for each of the predefined variable in study.
Study Design
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Study Design:Final Phase
PARTICIPANTS AND METHODS
Full papers includedn=??
Study Design
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Variable description and data collection:Article peer-review to extract information data about :
Study characteristics:• name of first author
• year of publication
• country of origin
• type of study
• sample size
Preoperative clinical variables:• age
• risk factors exposition
• patient’s condition
• aneurysm diameter
Postoperative Clinical variables: venous bleeding gastrointestinal ischemia renal failure myocardial infarction respiratory complications clinical outcome <30 days
PARTICIPANTS AND METHODS
Variables in study
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Planed statistical analysis
• Data input on Database using Statistical Package for Social Sciences
(SPSS) or Review Manager (RevMan) software
• Analysis of the frequency of each factor/complication
• Selection of the most common postoperative complications
• Estimation of Relative Risk (RR) of each factor for mortality
• Comparison of mortality rates with clinical and outcome history
PARTICIPANTS AND METHODS
Statistical Analysis
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Limits of the study
We are aware that the Query we have applied may not be specific
enough due to:
1. Inexistence of a unique term to define “elective open repair”
2. The number of risk factors and postoperative complications
3. Difficulty to define the outcome<30 days after repair
Limits
RESULTS
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Expected Results
• Summarize the mortality rates and Identify the postoperative complications more commonly associated with failure after EOR
• Provide “strong” evidences for prediction of patient’s outcome after EOR based on the clinical evidences and postoperative complications
Expected Results
RESULTS
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Current situation
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ID Nom e da Tarefa Duration Start Finish Predeces sorsResource Names
1 Phase 1 13 days Wed 10-10-07 Mon 29-10-07
2 Identification of problem 1 day Wed 10-10-07 Wed 10-10-07 Class 5
3 Work planning 5 days Thu 11-10-07 Wed 17-10-07 2 Class 5
4 Literature research about Elective Open Repair AAA 2 days Thu 11-10-07 Fri 12-10-07 2 Henrique Messias[25%];Ana Pinto[25%];Joana Teixeira[25%];Luís Mendes [25%]
5 Definition of MeSH terms to include in the Query 0,5 days Fri 12-10-07 Fri 12-10-07 4SS;2 Class 5
6 Definition of query 0,5 days Fri 12-10-07 Fri 12-10-07 5 Class 5
7 Application of query in PUBMED databas e 0,25 days Mon 15-10-07 Mon 15-10-07 6 Class 5
8 Definition of m ethods 1 day Thu 11-10-07 Thu 11-10-07 7 Sérgio Cardoso;Sílvia Farraposo;Joana Teixeira;Rafaela Parreira
9 Writing of protocol draft 5 days Mon 15-10-07 Fri 19-10-07 8 Hugo Sousa;Sofia Figueiredo;Filipa Figueiredo;Filipa Gomes
10 Elaboration of Powerpoint presentation 2 days Thu 25-10-07 Fri 26-10-07 9 Ana Pinto;Catarina Machado;Miguel Mascarenhas ;Luís Mendes
11 Firs t presentation 0 days Mon 29-10-07 Mon 29-10-07 10 Miguel Mascarenhas [50%];Ana Pinto[50%]
12 Phase 2 37 days Wed 31-10-07 Fri 21-12-07 1
13 Review of Query 0,25 days Wed 31-10-07 Wed 31-10-07 Class 5
14 Re-application of query in PUBMED database 0,25 days Wed 31-10-07 Wed 31-10-07 13 Class 5;Hugo Sousa
15 Definition of inclusion/exclusion criteria 0,5 days Wed 31-10-07 Wed 31-10-07 14 Class 5
16 Review and Selection of Abstracts 23 days Thu 01-11-07 Mon 03-12-07 14
17 Dis tribution of abs tracts for review 0,25 days Thu 01-11-07 Thu 01-11-07 14;15 Hugo Sousa;Luís Mendes
18 Analys is of abstracts with inclusion/exclusion criteria 17 days Thu 01-11-07 Fri 23-11-07 14;15;17 Class 5
19 Definition of variables to extract 1 day Mon 03-12-07 Mon 03-12-07 18 Hugo Sousa[50%];Class 5[50%]
20 Elaboration of Gant Map 5 days Mon 03-12-07 Fri 07-12-07 15 Sílvia Farraposo[70%];Sofia Figueiredo[20%];Hugo Sousa[10%]
21 Elaboration of Workflows 5 days Mon 03-12-07 Fri 07-12-07 8;9;14;20 Rafaela Parreira[25%];Sílvia Farraposo[50%];Filipa Figueiredo[25%]
22 Writing of protocol 12 days Mon 03-12-07 Tue 18-12-07 16 Hugo Sousa[25%];Sofia Figueiredo[15%];Filipa Gomes[10%];Henrique Mess ias [10%];Miguel Mascarenhas [10%];Joana Teixeira[10%];Catarina Machado[10%];Ana Pinto[10%];Luís Mendes [5%]
23 Elaboration of Powerpoint presentation 4 days Fri 14-12-07 Wed 19-12-07 22SS Sérgio Cardoso;Henrique Mes sias ;Hugo Sous a;Sofia Figueiredo
24 Second presentation 0 days Fri 21-12-07 Fri 21-12-07 23 Henrique Messias[50%];Sérgio Cardoso[50%]
CURRENT SITUATION
Gant Map (Phase 1 and 2)
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FUTURE WORK
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ID Nom e da Tarefa Duration Start Finish Predeces sorsResource Names
25 Phase 3 30 days Mon 28-01-08 Mon 10-03-08 12
26 Review and Analysis of Papers 25 days Mon 28-01-08 Fri 29-02-08
27 Dis tribution of papers for peer-review 0 days Mon 28-01-08 Mon 28-01-08 Class 5;Hugo Sousa;Luís Mendes
28 Analys is of papers 23 days Mon 28-01-08 Wed 27-02-08 27 Class 5
29 inclusion/exclusion criteria filtering 2 days Thu 28-02-08 Fri 29-02-08 28 Class 5
30 Elaboration of Powerpoint presentation 5 days Mon 03-03-08 Fri 07-03-08 26SS Joana Teixeira;Rafaela Parreira;Catarina Machado;Ana Pinto
31 Third presentation 0 days Mon 10-03-08 Mon 10-03-08 30 Class 5
32 Phase 4 50 days Mon 24-03-08 Mon 02-06-08 25
33 Extraction and Analysis of Data 29 days Mon 24-03-08 Thu 01-05-08
34 Data extraction from included papers 10 days Mon 24-03-08 Fri 04-04-08 29 Hugo Sousa;Sofia Figueiredo;Filipa Figueiredo;Sílvia Farraposo;Ana Pinto;Luís Mendes ;Joana Teixeira
35 Data compilation on SPSS database 5 days Mon 07-04-08 Fri 11-04-08 34 Sérgio Cardoso;Henrique Mes sias ;Luís Mendes;Miguel Mascarenhas
36 Statystical Analys is 10 days Fri 18-04-08 Thu 01-05-08 35 Hugo Sousa;Class 5
37 On-line presentation of res ults 15 days Mon 28-04-08 Fri 16-05-08 41SS Sílvia Farraposo;Luís Mendes ;Joana Teixeira;Rafaela Parreira;Catarina Machado;Henrique Mess ias
38 Elaboration of Powerpoint presentation 5 days Mon 26-05-08 Fri 30-05-08 40SS Hugo Sousa;Luís Mendes;Catarina Machado;Miguel Mascarenhas
39 Final pres entation 0 days Mon 02-06-08 Mon 02-06-08 38 Class 5
40 Complete Writing of Paper 31 days Mon 14-04-08 Mon 26-05-08 22
41 Writing of Results 10 days Mon 14-04-08 Fri 25-04-08 35 Hugo Sousa[50%];Class 5[50%]
42 Writing of Discuss ion 10 days Mon 28-04-08 Fri 09-05-08 41 Hugo Sousa;Class 5
43 Writing of Conclus ion 5 days Mon 12-05-08 Fri 16-05-08 42 Hugo Sousa;Class 5
44 Paper review and corrections 5 days Tue 20-05-08 Mon 26-05-08 43 Class 5;Sílvia Farraposo;Hugo Sous a
FUTURE WORK
Gant Map (Phase 3 and 4)
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Elective Open Repair of Abdominal Aortic Aneurysms (AAA):
A Systematic Review of Risk Factors for Associated Mortality
Dezembro 2007
Turma 5 - 1º ano Mestrado Integrado em Medicina, FMUP