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Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Ischaemic colitis is an infrequent but serious complication following repair of abdominal aortic aneurysm (AAA), with high mortality rates. This systematic review set out to identify risk factors for the development of ischaemic colitis after AAA surgery.

Methods

A systematic search of the MEDLINE, EMBASE and CINAHL databases was performed. This search was limited to studies published in the English language after 1990. Abstracts were screened by two authors. Eligible studies were obtained as full text for further examination. Data was extracted by two authors, and any disputes were resolved via consensus. Extracted data was pooled using Mantel-Haenszel random effects models. Bias was assessed using two Cochrane-approved tools. Effect sizes are expressed as relative risk ratios alongside the 95 % confidence interval. Statistical significance was defined at the level of p < 0.05.

Results

From 388 studies identified in the initial search, 33 articles were included in the final synthesis and analysis. Risk factors were grouped into patient (female gender, disease severity) and operative factors (peri-procedural hypotension, operative modality). The risk of ischaemic colitis was significantly higher when undergoing emergency repair versus elective (risk ratio (RR) 7.36, 3.08 to 17.58, p < 0.001). Endovascular repair reduced the likelihood of ischaemic colitis (RR 0.22, 0.12 to 0.39, p < 0.001).

Discussion

The quality of published evidence on this subject is poor with many retrospective datasets and inconsistent reporting across studies. Despite this, emergency presentation and open repair should prompt close monitoring for the development of IC.

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Authors and Affiliations

  1. Department of General Surgery, Northern General Hospital, First Floor, Old Nurses Home Herries Road, Sheffield, UK, S5 7AU

    Matthew J. Lee, Sarah L. Daniels & Ian J. Adam

  2. Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK

    Matthew J. Lee & Thomas M. Drake

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  1. Matthew J. Lee
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  2. Sarah L. Daniels
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Correspondence to Matthew J. Lee.

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MJL has no conflicts of interest to declare. SLD has no conflicts of interest to declare. TMD has no conflicts of interest to declare. IJA has no conflicts of interest to declare. Parts of this project have been presented to the Society of Academic & Research Surgery, the Association of Surgeons of Great Britain and Ireland and the Asia-Pacific Federeration of Coloproctology.

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What this paper adds

This is the first systematic review and observational meta-analysis to collate risk factors for ischaemic colitis following abdominal aortic aneurysm repair. Emergency presentation and open surgery are associated with increased risk. Factors related to hypoperfusion such as hypotension, large volume blood transfusion and prolonged operative time are also implicated.

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Lee, M.J., Daniels, S.L., Drake, T.M. et al. Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis. Int J Colorectal Dis 31, 1273–1281 (2016). https://doi.org/10.1007/s00384-016-2606-6

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  • DOI: https://doi.org/10.1007/s00384-016-2606-6

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