Blankensteijn J D, Lindenburg F P, Van der Graaf Y, Eikelboom B C
Department of Surgery, University Hospital Utrecht, The Netherlands.
Br J Surg. 1998 Dec;85(12):1624-30. doi: 10.1046/j.1365-2168.1998.00922.x.
The mortality and morbidity rates of elective abdominal aortic aneurysm (AAA) surgery, as reported over the past 12 years, were graded and analysed by levels of evidence.
Articles on elective AAA surgery published between 1985 and 1996 were retrieved and classified into five levels of evidence. Level 1 contains prospective studies and is subdivided into population-based (level 1a) and hospital-based (level 1b) studies. Level 2 includes retrospective studies, subdivided into population-based studies (level 2a), hospital-based studies (level 2b) and hospital-based studies concerning a specified group of selected patients (level 2c). Operative mortality and systemic and local/vascular complication rates with 95 per cent confidence intervals were calculated for each level of evidence.
Seventy-two articles describing a total of 37 654 patients could be included: two level 1a studies (692 patients), nine level 1b studies (1677 patients), 13 level 2a studies (21 409 patients), 32 level 2b studies (12019 patients) and 16 level 2c studies (1857 patients). The mean 30-day mortality rates of the two population-based levels were similar: 8.2 (95 per cent confidence interval 6.4-10.6) per cent for the prospective (la) and 7.4 (7.0-7.7) per cent for the retrospective (2a) series. These figures were significantly higher than the remarkably similar hospital-based mortality rates: 3.8 (3.0-4.8) per cent for the prospective (1b), 3.8 (3.5-4.2) per cent for the retrospective (2b) and 3.5 (2.8-4.4) per cent for selected patient group (2c) studies. The most frequent complication was of cardiac origin. In the population-based series the cardiac complication rates were 10.6 (8.5-13.2) and 11.1 (9.1-13.6) per cent for levels 1a and 2a respectively. This compared well with 12.0 (10.5-13.9) per cent for the prospective hospital-based series (level 1b). The cardiac complication rates in the retrospective hospital-based studies were significantly lower: 8.9 (8.4-9.5) and 6.1 (4.9-7.6) per cent for levels 2b and 2c respectively.
There is a clear and consistent disagreement in reported mortality rates between hospital-based and population-based studies of elective surgery for AAA. Prospective studies give the best documentation of postoperative morbidity.
过去12年报道的择期腹主动脉瘤（AAA）手术的死亡率和发病率，根据证据水平进行了分级和分析。
检索1985年至1996年间发表的关于择期AAA手术的文章，并分为五个证据水平。1级包括前瞻性研究，细分为基于人群的研究（1a级）和基于医院的研究（1b级）。2级包括回顾性研究，细分为基于人群的研究（2a级）、基于医院的研究（2b级）以及关于特定选定患者组的医院研究（2c级）。计算每个证据水平的手术死亡率以及全身和局部/血管并发症发生率，并给出95%置信区间。
共纳入72篇描述37654例患者的文章：2篇1a级研究（692例患者）、9篇1b级研究（1677例患者）、13篇2a级研究（21409例患者）、32篇2b级研究（12019例患者）和16篇2c级研究（1857例患者）。两个基于人群水平的30天平均死亡率相似：前瞻性（1a）系列为8.2%（95%置信区间6.4 - 10.6），回顾性（2a）系列为7.4%（7.0 - 7.7）。这些数字显著高于非常相似的基于医院的死亡率：前瞻性（1b）为3.8%（3.0 - 4.8），回顾性（2b）为3.8%（3.5 - 4.2），选定患者组（2c）研究为3.5%（2.8 - 4.4）。最常见的并发症源自心脏。在基于人群的系列中，1a级和2a级的心脏并发症发生率分别为10.6%（8.5 - 13.2）和11.1%（9.1 - 13.6）。这与前瞻性基于医院的系列（1b级）的12.0%（10.5 - 13.9）相比情况较好。回顾性基于医院的研究中的心脏并发症发生率显著较低：2b级为8.9%（8.4 - 9.5），2c级为6.1%（4.9 - 7.6）。
在AAA择期手术的基于医院和基于人群的研究中，报道的死亡率存在明显且一致的差异。前瞻性研究能最好地记录术后发病率。
