Screening for abdominal aortic aneurysm reduces overall mortality in men. A meta-analysis of the mid- and long-term effects of screening for abdominal aortic aneurysms

Background: Four randomised controlled trials of screening older men for abdominal aortic aneurysms (AAA) have been completed. A meta-anatysis was performed to examine the pooled effects of screening on both mid- and long-term AAA-retated and total mortatity, and operations for AAA. Methods: Pooled mid-term (31/2-5 years) and Long term (7-15 years) effects were calculated as odds-ratios (ORs) with 95% confidence intervals in fixed effect models. Long-term data from the West Australian trial were limited to all-caurse deaths. Heterogeneity between the studies was assessed by the chi 2- test. In cases of heterogeneity, random effect models were used. Results: The pooled mid-term analysis showed the offer of screening caused a significant reduction in AAA related mortality (OR = 0.56, 95% C.I. 0.44,0.72), and emergency operations (OR = 0.55, 95% C.I.: 0.39; 0.76), white the number of elective operations increased significantly (OR = 3.27, 95% C.I.: 2.14; 5.00). Overall mortality was reduced, but not significantly (OR = 0.94, 95% C.I.: 0.86; 1.02). The long-term results also showed a significant reduction in AAA-retated mortality (OR = 0.47, 95% C.I.: 0.25; 0.90), overall mortality (OR = 0.94, 95% C.I.: 0.92; 0.97) and emergency operations (OR = 0.48, 95% C.I.: 0.28; 0.83), white the number of elective operations increased significantly (OR = 2.81, 95% C.I.: 2.40; 3.30). Conclusion: Population screening for AAA reduces AAA-retated and overall mortality, however local differences may exits which could influence cost effectiveness of screening. (C) 2008 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.