Methods

 

 

Data Search and Trial Selection

 

Based on the aim of our study, it was performed a systematic review using Medline (Pubmed), The Controlled Trials Register (The Cochrane Library) and ISI Web of Knowledge online databases. Besides the following query,  a few restrictions and limits have been introduced during our research.

 

Query:
        ( “Abdominal Aortic Aneurysm” [MeSH] OR “AAA”) AND (“Quality of Life” OR “Health Care Quality Indicators” [MeSH] OR “QOL”) AND (“Endovascular Repair” OR “Endoluminal Repair” [MeSH] OR “EVAR”) AND (“Open Repair” OR “Surgery Repair” )

Limits:

Language: English

Humans or animals: humans

 

It was used this language limit because all Portuguese papers usually exist also in English. As EVAR is a very recent technique (less than 10 years), it was not necessary to establish years or date of publication limits.

 

All the papers found with the query (from the earliest available until December 2007) were reviewed and selected to be included in our study if they respected all the inclusion criteria defined.

 

 

 Exclusion and Inclusion Criteria

 

The first phase of papers selection consisted on the application of the inclusion criteria in all the articles found. Five groups, composed by two reviewers, included the papers that respected the following criteria: compare quality of life after EVAR and OPEN repair; include patients over forty years in the sample analysed; use SF-36 to evaluate quality of life parameters; mention the methods used and results; studies in humans. As a strategy of solving disagreement points it was incorporate a third element of the group (third reviewer).

On the following stage, other five groups composed by two reviewers continued the selection by reading the full text and excluding the papers which: were not directly related to the aim of our review; compare both techniques (EVAR and OPEN) but do not refer pos-operative quality of life or focus on parameters that don’t relate it directly; papers written in an inaccessible language; articles in which only abstract is available and it’s not possible to obtain the complete article. In the same way, as a strategy of solving disagreement points it was incorporate a third element of the group (third reviewer).

Finally, five papers were obtained.

 

 

 Outcomes

 

The considered outcomes were, primarily, the comparison of quality of life, between evar and open repair obtained from SF-36 total scores; and secondarily, comparison of singular parameters scores from SF-36 between open and EVAR.

At the end, six papers were obtained.

 

 

 Statistical Analysis and data aggregation

 

Previously to the elaboration of the systematic review, a statistical analysis was performed using the SPSS software (explain in this website     https://stat2.med.up.pt/cursop/main.php3?capitulo=introspss&numero=1&titulo=Introdu%E7%E3o%2Bao%2BSPSS). The data from the final included articles was aggregated to compare final scores of SF-36 after Open and EVAR repair, calculating the arithmetic difference between open and EVAR scores. This way, we compared both procedures. A positive result corresponds to a higer score to OPEN repair, that is a better quality of life for patients undergoing to this type of surgery. A negative result corresponds to a better quality of life for patients submitted to EVAR. The differences obtained were summarized using several graphs corresponding to each moment of the follow-up period analysed (first month, third month, sixth month and one year – the ones more frequently referred through papers analysed). In order to take a general view of all papers, we built another graph showing the mean evolution of the total scores in both procedures through follow-up period.