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      Individual‐patient meta‐analysis of three randomized trials comparing endovascular versus open repair for ruptured abdominal aortic aneurysm

      2 , 3 , 4 , 1 , , 1 , Ruptured Aneurysm Trialists 5 , 5 , 5 , 5 , 5 , 5 , 5 , 5 , 5 , 5 , 6 , 6 , 6 , 7 , 7 , 7 , 7 , 7 , 7 , 7 , 7 , 7 , 7 , 8 , 8 , 8 , 8 , 8 , 8 , 8 , 8 , 8 , 8 , 8 , 9 , 9 , 9 , 10 , 10 , 11 , 11 , 12 , 12 , 12 , 13 , 13 , 14 , 14 , 15 , 15 , 15 , 16 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 17 , 18 , 18 , 18 , 19 , 19 , 19 , 20 , 20 , 20 , 20 , 21 , 21 , 21 , 21 , 22 , 22 , 22 , 22 , 23 , 23 , 23 , 24 , 24 , 24 , 25 , 25 , 25 , 26 , 26 , 27 , 28 , 28 , 28 , 28 , 28 , 29 , 30 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 43 , 44 , 44 , 45 , 46 , 47 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 65 , 66 , 67 , 68 , 68 , 69 , 70 , 71 , 71

      The British Journal of Surgery

      John Wiley & Sons, Ltd

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          The benefits of endovascular repair of ruptured abdominal aortic aneurysm remain controversial, without any strong evidence about advantages in specific subgroups.

          Methods

          An individual‐patient data meta‐analysis of three recent randomized trials of endovascular versus open repair of abdominal aortic aneurysm was conducted according to a prespecified analysis plan, reporting on results to 90 days after the index event.

          Results

          The trials included a total of 836 patients. The mortality rate across the three trials was 31·3 per cent for patients randomized to endovascular repair/strategy and 34·0 per cent for those randomized to open repair at 30 days (pooled odds ratio 0·88, 95 per cent c.i. 0·66 to 1·18), and 34·3 and 38·0 per cent respectively at 90 days (pooled odds ratio 0·85, 0·64 to 1·13). There was no evidence of significant heterogeneity in the odds ratios between trials. Mean(s.d.) aneurysm diameter was 8·2(1·9) cm and the overall in‐hospital mortality rate was 34·8 per cent. There was no significant effect modification with age or Hardman index, but there was indication of an early benefit from an endovascular strategy for women. Discharge from the primary hospital was faster after endovascular repair (hazard ratio 1·24, 95 per cent c.i. 1·04 to 1·47). For open repair, 30‐day mortality diminished with increasing aneurysm neck length (adjusted odds ratio 0·69 (95 per cent c.i. 0·53 to 0·89) per 15 mm), but aortic diameter was not associated with mortality for either type of repair.

          Conclusion

          Survival to 90 days following an endovascular or open repair strategy is similar for all patients and for the restricted population anatomically suitable for endovascular repair. Women may benefit more from an endovascular strategy than men and patients are, on average, discharged sooner after endovascular repair.

          Abstract

          Strong evidence of equivalence

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          Most cited references 22

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          Measuring inconsistency in meta-analyses.

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            Meta-analysis in clinical trials.

            This paper examines eight published reviews each reporting results from several related trials. Each review pools the results from the relevant trials in order to evaluate the efficacy of a certain treatment for a specified medical condition. These reviews lack consistent assessment of homogeneity of treatment effect before pooling. We discuss a random effects approach to combining evidence from a series of experiments comparing two treatments. This approach incorporates the heterogeneity of effects in the analysis of the overall treatment efficacy. The model can be extended to include relevant covariates which would reduce the heterogeneity and allow for more specific therapeutic recommendations. We suggest a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
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              Multiple imputation using chained equations: Issues and guidance for practice.

              Multiple imputation by chained equations is a flexible and practical approach to handling missing data. We describe the principles of the method and show how to impute categorical and quantitative variables, including skewed variables. We give guidance on how to specify the imputation model and how many imputations are needed. We describe the practical analysis of multiply imputed data, including model building and model checking. We stress the limitations of the method and discuss the possible pitfalls. We illustrate the ideas using a data set in mental health, giving Stata code fragments. 2010 John Wiley & Sons, Ltd.
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                Author and article information

                Journal
                Br J Surg
                Br J Surg
                10.1002/(ISSN)1365-2168
                BJS
                The British Journal of Surgery
                John Wiley & Sons, Ltd (Chichester, UK )
                0007-1323
                1365-2168
                24 June 2015
                September 2015
                : 102
                : 10 ( doiID: 10.1002/bjs.2015.102.issue-10 )
                : 1229-1239
                Affiliations
                [ 1 ] Vascular Surgery Research GroupImperial College, Charing Cross Hospital LondonUK
                [ 2 ] Department of Public Health and Primary CareUniversity of Cambridge CambridgeUK
                [ 3 ] Department of Vascular SurgeryAcademic Medical Centre AmsterdamThe Netherlands
                [ 4 ] Vascular Surgery UnitHospital Henri Mondor CréteilFrance
                [ 5 ]Academic Medical Centre AmsterdamThe Netherlands
                [ 6 ]trial coordinators; Academic Medical Centre AmsterdamThe Netherlands
                [ 7 ]Onze Lieve Vrouwe Gasthuis AmsterdamThe Netherlands
                [ 8 ]VU University Medical Centre AmsterdamThe Netherlands
                [ 9 ]Sint Lucas Andreas Ziekenhuis AmsterdamThe Netherlands
                [ 10 ]Slotervaartziekenhuis AmsterdamThe Netherlands
                [ 11 ]Boven IJ Ziekenhuis AmsterdamThe Netherlands
                [ 12 ]Ziekenhuis Amstelland AmstelveenThe Netherlands
                [ 13 ]Waterlandziekenhuis PurmerendThe Netherlands
                [ 14 ]Zaans Medisch Centrum ZaandamThe Netherlands
                [ 15 ]Spaarne Ziekenhuis HoofddorpThe Netherlands
                [ 16 ]Regional ambulance services
                [ 17 ]Centre Hospitalier Universitaire (CHU) Henri Mondor CréteilFrance
                [ 18 ]CHU Bichat ParisFrance
                [ 19 ]CHU Dijon DijonFrance
                [ 20 ]Centre Hospitalier Régional Universitaire (CHRU) Lille LilleFrance
                [ 21 ]Hôpital Nord Marseille MarseilleFrance
                [ 22 ]CHU Marseille MarseilleFrance
                [ 23 ]CHU Montpellier MontpellierFrance
                [ 24 ]CHU Hôpital Européen Georges‐Pompidou ParisFrance
                [ 25 ]CHU Brest BrestFrance
                [ 26 ]CHU Saint Etienne Saint EtienneFrance
                [ 27 ]CHRU Tours ToursFrance
                [ 28 ]CHU Nice NiceFrance
                [ 29 ]Centre Hospitalier Régional Annecy AnnecyFrance
                [ 30 ]CHU Lyon LyonFrance
                [ 31 ] ChairImperial College London UK
                [ 32 ]University Hospital of South Manchester ManchesterUK
                [ 33 ]London School of Hygiene and Tropical Medicine LondonUK
                [ 34 ]Imperial College London UK
                [ 35 ]London School of Hygiene and Tropical Medicine LondonUK
                [ 36 ]St George's Hospital LondonUK
                [ 37 ]University of Cambridge CambridgeUK
                [ 38 ]St George's Hospital LondonUK
                [ 39 ]University of Cambridge CambridgeUK
                [ 40 ]Imperial College London UK
                [ 41 ]Imperial College Healthcare NHS Trust LondonUK
                [ 42 ]Addenbrooke's Hospital CambridgeUK
                [ 43 ]Manchester Royal Infirmary ManchesterUK
                [ 44 ]St George's Hospital LondonUK
                [ 45 ]Guy's and St Thomas’ Hospital LondonUK
                [ 46 ]Kent and Canterbury Hospital CanterburyUK
                [ 47 ]Leicester Royal Infirmary LeicesterUK
                [ 48 ]Royal Free Hospital LondonUK
                [ 49 ]University Hospital of South Manchester ManchesterUK
                [ 50 ]Leeds General Infirmary LeedsUK
                [ 51 ]Freeman Hospital Newcastle upon TyneUK
                [ 52 ]King's College Hospital LondonUK
                [ 53 ]Aberdeen Royal Infirmary AberdeenUK
                [ 54 ]James Cook University Hospital MiddlesbroughUK
                [ 55 ]Queen's Medical Centre NottinghamUK
                [ 56 ]Royal Cornwall Hospital TruroUK
                [ 57 ]Royal Bournemouth Hospital BournemouthUK
                [ 58 ]Royal Sussex County Hospital BrightonUK
                [ 59 ]Queen Elizabeth Hospital GatesheadUK
                [ 60 ]Hull Royal Infirmary HullUK
                [ 61 ]Colchester General Hospital ColchesterUK
                [ 62 ]Frimley Park Hospital FrimleyUK
                [ 63 ]Ninewells Hospital DundeeUK
                [ 64 ]Royal Gwent Hospital NewportUK
                [ 65 ]University Hospital of Wales CardiffUK
                [ 66 ]New Cross Hospital WolverhamptonUK
                [ 67 ]Doncaster Royal Infirmary DoncasterUK
                [ 68 ]Royal Derby Hospital DerbyUK
                [ 69 ]University Hospital of North Staffordshire Stoke‐on‐TrentUK
                [ 70 ]York Hospital YorkUK
                [ 71 ] London Health Sciences CentreUniversity of Western Ontario London OntarioCanada
                Author notes
                [* ] Correspondence to: Professor J. T. Powell, Vascular Surgery Research Group, Imperial College, Charing Cross Hospital, Fulham Palace Road, London W6 8RP, UK (e‐mail: j.powell@ 123456imperial.ac.uk )
                Article
                BJS9852
                10.1002/bjs.9852
                4744980
                26104471
                © 2015 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                Page count
                Pages: 11
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                2.0
                bjs9852
                September 2015
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.7.6 mode:remove_FC converted:04.02.2016

                Surgery

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