Final 12-year follow-up of surgery versus surveillance in the UK small aneurysm trial
Final 12-year follow-up of surgery versus surveillance in the UK small aneurysm trial
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DOI：
10.1002/bjs.5778
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发表时间：
2007-06-01
影响因子：
9.6
通讯作者：
Thompson, S. G.
中科院分区：
文献类型：
--
作者：
Powell, J. T.;Brown, L. C.;Thompson, S. G.
工作背景：目的是确定早期开放手术修复是否有利于小腹主动脉瘤患者与长期follows.Methods：1090例患者谁被纳入英国小动脉瘤试验1991年和1995年之间的动脉瘤修复和死亡率随访至2005年11月。结果：截至2005年11月，714名患者（65.5%）死亡，929名（85.2%）接受了动脉瘤修复术，150名（13.8%）未经动脉瘤修复术死亡，11名（1.0%）未经动脉瘤修复术存活。12年后，手术组和监测组的死亡率分别为63.9%和67.3%，未校正的风险比为0.90（P=0.139）。四分之三的监测组最终接受了动脉瘤修复术，30天择期死亡率为6.3%（早期手术组为5.0%，P=0.366）。据估计，早期手术组的治疗费用高出17%，平均差异为1326磅。这些患者的死亡率约为年龄和性别相匹配的人群的两倍。结论：早期选择性开放修复小腹主动脉瘤没有长期生存的好处。即使在成功的动脉瘤修复后，这些患者的死亡率也高于一般人群。
Background: The aim was to determine whether early open surgical repair would benefit patients with small abdominal aortic aneurysm compared with surveillance on long-term follow-up.Methods: The 1090 patients who were enrolled into the UK Small Aneurysm Trial between 1991 and 1995 were followed up for aneurysm repair and mortality until November 2005.Results: By November 2005, 714 patients (65.5 per cent) had died, 929 (85.2 per cent) had undergone aneurysm repair, 150 (13.8 per cent) had died without aneurysm repair and 11 (1.0 per cent) remained alive without aneurysm repair. After 12 years, mortality in the surgery and surveillance groups was 63.9 and 67.3 percent respectively, unadjusted hazard ratio 0.90 (P=0.139). Three-quarters of the surveillance group eventually had aneurysm repair, with a 30-day elective mortality of 6.3 per cent (versus 5.0 per cent in the early surgery group, P=0.366). Estimates suggested that the cost of treatment was 17 per cent higher in the early surgery group, with a mean difference of 1326 pound. The death rate in these patients was about twice that in the population matched for age and sex.Conclusion: There was no long-term survival benefit of early elective open repair of small abdominal aortic aneurysms. Even after successful aneurysm repair, the mortality among these patients was higher than in the general population.