Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
School of Medicine, University College Dublin, Dublin, Ireland.
BMJ Open. 2022 Oct 28;12(10):e061420. doi: 10.1136/bmjopen-2022-061420.
Endovascular aneurysm repair (EVAR) has a marked short-term advantage over open surgical repair in managing abdominal aortic aneurysms (AAA); however, this benefit is lost in the long term. The current trend towards stratified medicine has given rise to diverse prognostic prediction models and scoring systems for EVAR. These models could act as decision support tools that employ patient and operative factors, to improve long-term outcomes. Past literature evaluated and compared model performance for predicting one outcome, for example, mortality. None were deemed competent for clinical application. The proposed study will use a scoping review approach to capture literature on prognostic modelling in EVAR for all predictable outcomes. The results are anticipated to inform future research, identify knowledge gaps, and assist in determining the potential of models for clinical use.
The proposed study will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping Reviews as a framework for conducting the review. PubMed Central, Embase and Cochrane Library will be searched and screened for peer-reviewed studies on prognostic modelling for EVAR, published between 2000 and 2022. No limits exist on predictor variables used and outcomes predicted by the model for inclusion, provided they apply to AAA patients managed with EVAR. Data will be abstracted using a charting form based on the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies guidelines and PRISMA guidelines for systematic reviews. The Prediction model Risk of Bias Assessment Tool and the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis checklist will be used to critically appraise included studies.
Since scoping reviews cover secondary data from published literature, ethical approval is not required. The findings will be disseminated via peer-reviewed publications and presentations at key conferences.
血管内动脉瘤修复术（EVAR）在治疗腹主动脉瘤（AAA）方面具有明显的短期优势，优于开放手术修复；然而，这种优势在长期内会丧失。当前，分层医学的趋势催生了多种用于 EVAR 的预后预测模型和评分系统。这些模型可以作为决策支持工具，利用患者和手术因素来改善长期结果。过去的文献评估和比较了用于预测单一结果（例如死亡率）的模型性能。但没有一个被认为具有临床应用的能力。拟议的研究将使用范围综述方法来捕获关于所有可预测结果的 EVAR 预后建模的文献。预计研究结果将为未来的研究提供信息，确定知识空白，并有助于确定模型在临床应用中的潜力。
拟议的研究将使用系统评价和荟萃分析的首选报告项目（PRISMA）扩展范围综述作为进行综述的框架。将在 PubMed Central、Embase 和 Cochrane Library 中搜索和筛选 2000 年至 2022 年期间发表的关于 EVAR 预后建模的同行评审研究。纳入的预测变量和模型预测的结果没有限制，只要它们适用于接受 EVAR 治疗的 AAA 患者。将使用基于系统评价预测模型研究的关键评估和数据提取指南以及 PRISMA 系统评价指南的图表表格来提取数据。将使用预测模型风险偏倚评估工具和用于个体预后或诊断的多变量预测模型的透明报告清单来批判性地评估纳入的研究。
由于范围综述涵盖了已发表文献中的二级数据，因此不需要伦理批准。研究结果将通过同行评审出版物和在关键会议上的演示进行传播。
