Discussion

AAA are associated with considerable morbidity, mortality and health-care costs. Elective Open repair has traditionally been considered the intervention of choice to reduce the risk of rupture and improve survival in individuals at high risk of rupture. Nevertheless, EVAR has become widely used based on belief that it may provide long-term prevention of ruptures with low intervention morbidity and mortality and improved length and quality of life.

When comparing the absolute scores between both procedures (first outcome), at 1 month the OR group had significantly lower scores on physical function, social functioning, role-emotional, mental health, bodily pain and general health. At 6 months postoperatively physical function, social functioning, mental health, vitality, bodily pain and general health scores in the OR was significantly higher than in the EVAR group. At 12 months, the physical-function, social-functioning, role-physical, mental health, vitality, bodily pain and general health scores were significantly higher in the OR group.

On the other side, when analysing the parameters one by one (second outcome)  we see that in what concerns to physical function the papers agree to state that until the first month the scores on patients submitted to OR were lower than on patients submitted to EVAR. However in the first month there is a change showing a better quality of life in the parameter physical function in patients submitted to OR. In the parameter social function there was no unanimity between papers, but a greater percentage of them support that scores in patients submitted to OPEN are lower than in that ones submitted to EVAR until the first six weeks. After the sixth week there is an inversion of the results with the patients submitted to OR having higher scores in what concerns to social function. In the role physical, the patients submitted to OR have lower scores than the patients submitted to EVAR during all the postoperative period, except at the sixth month. A great divergence was noticed when analyzing the parameter role emotional in what concerns to postoperative scores, with periods of time that patients treated with OR had higher scores (1 week, 2 months, 6 months and 1 year), and with the other periods analyzed that patients submitted to EVAR had higher scores.  In mental health there is a great similarity of scores in patients submitted to OR or to EVAR. Analyzing the vitality, until the first three months after the surgery there are some periods that patients submitted to EVAR had higher scores (1 week, 3 weeks, 6 weeks and 2 months), and periods that this patients had lower scores. After the third month, there are better scores of vitality on patients submitted to OR. Checking now the parameter bodily pain, the papers agree that the patients submitted to OR have higher scores than that ones submitted to EVAR. Finally, in the last parameter general health the papers agree in showing that patients submitted to OR had higher scores until the second month after surgery. There is a change at the third month, when patients submitted to EVAR presented higher scores. After the sixth month, once more patients treated with OR had higher scores.

In that way, we can say that the parameters role emotional and mental health are not affected by the kind of surgery (OR or EVAR).

It’s good to notice that to higher scores should be given different meanings. So higher scores of physical function, social function, role physical, role emotional, mental health, vitality and general health are benefits to the patient, however an higher score on bodily pain it is not a benefit.

As was expected, the results of the second outcome are in agreement with the results of the first outcome: in the postoperative period, until the first two/three months there is a better quality of life on patients submitted to EVAR, but the situation changes after this moment.

One limitation to our study is that the data provided by each one of the analysed papers was collected in different stages of post-operative period nevertheless they had few common points. Moreover, some papers include only SF-36 global scores and didn’t analyse individual score criteria making it difficult to perform an analysis focused on the differences between each domain (e.g. mental health, pain, …)