Editor’s pick by Michael Kidd: Our first meta-analysis of case reports

Case report
Predictors of adverse events after endovascular abdominal aortic aneurysm repair. A meta-analysis of case reports.
Felix JV Schlosser, Geert JMG van der Heijden, Yolanda van der Graaf, Frans L Moll, Hence JM Verhagen

This is one, if not the, first meta-analysis of case reports. While case reports do not provide strong causal evidence because they report only a small number of patients, case reports can provide relevant information, notably on long-term complications in the realm of patients actually seen and treated in daily practice.

This type of article can help to detect specific patterns of patient outcomes, particularly with regard to clinically important and rare adverse events and complications. Case reports may therefore offer valuable information about the mechanisms of the development of complications.

The aim of this study was to review which patient, disease or procedural characteristics predict complications after endovascular abdominal aorta aneurysm repair. The selection of case reports about patients with complications after this surgery may have resulted in a cohort of patients who are at high risk for complications, irrespective of the device or the procedure. Therefore, one may question whether these extraordinary patients may have brought the complications to the device or procedure. Although patients who were included in this study may represent the odd and extraordinary cases, they clearly are patients who are seen in practice. For ethical considerations and reasons of efficiency, these odd and extraordinary cases are generally excluded from randomised trials and cohort studies. The risk factors derived from the presented cohort of case reports are similar to those reported in prognostic cohort studies.  Hence, the results contribute to the robustness of the reported predictors.

Although a meta-analysis of case reports has some clear methodological drawbacks, it offers unique opportunities. The risk factors for complications after endovascular AAA repair that are presented in this document are similar to those that are presented in prognostic cohort studies. Female gender and the presence of comorbidities appear to increase the risk of mortality. Larger AAA diameter, higher age and multimorbidity at the time of surgery increase the risk for rupture and other complications following surgery. These risk factors deserve attention in future well-designed follow-up studies.

Professor Michael Kidd (pictured)
Journal of Medical Case Reports


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