The London team then analyzed the 30-day operative mortality rates for patients in the three fitness categories based on whether the patients had been treated with EVAR or open surgery.
Patients with good fitness were 83% less likely to die when they underwent EVAR, compared with open surgery, a statistically significant difference. Patients with moderate fitness had an 11% drop in mortality with EVAR, compared with open surgery, and poor fitness patients had a 53% reduced mortality, but a test for any difference across all the fitness ranges did now show any strongly significant results.
All-cause mortality during 5 years after surgery was roughly similar between the EVAR and open surgery groups for all three fitness subgroups. Although aneurysm-related deaths during 5-year follow-up were reduced by 52% in patients who were repaired by EVAR in the good fitness group, there was little evidence of difference across the fitness spectrum.
In short, the analysis showed no fitness group for which open surgery was superior to EVAR, but there was some evidence that EVAR may be a better option for patients who were most fit for AAA repair, Dr. Greenhalgh said. In addition, “there is a small but potentially definable group of patients for whom open surgery is not possible [because of the high risk that surgery poses], and EVAR will not save the day.”
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