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Sex Differences in Hospital Survival After AAA Repair
Quick Takes
- Women stayed longer in the hospital after aortic repair as well as experienced a higher in-hospital mortality rate.
- Furthermore, this sex-specific difference narrows slightly, but remains significant despite adjustment for age, comorbidities, anatomical complexity, anesthetic, year, standard-of-care, and postoperative complications.
- There is an urgent need for efforts to increase the rate of alive hospital discharge for women after aortic repair.
Study Questions:
What are the sex-specific differences and drivers of the rate of alive hospital discharge following infrarenal abdominal aortic aneurysm (AAA) repair?
Methods:
The investigators systematically examined the UK National Vascular Registry (UK NVR), 2014-2019 and Swedish National Patient Registry (SE NPR) of elective AAA patients, 2010-2018, for endovascular (EVAR) or open (OAR) aneurysm repair. Cox models assessed sex-specific differences in the rate of alive hospital discharge, adjusting for comorbidity, anatomy, standard-of-care, postoperative complications, and year, with in-hospital death as the competing risk.
Results:
A total of 29,751 AAA repairs (UK NVR – EVAR 12,518:1,532; OAR 6,803:837; SE NPR – EVAR 4,234:792; OAR 2,638:497, men:women) were assessed. For EVAR, the unadjusted rate of alive hospital discharge was approximately 25% lower for women (UK NVR: hazard ratio [HR] 0.75 [0.71-0.80], p < 0.001; SE NPR: HR 0.75 [0.69-0.81], p < 0.001). Following adjustment, the sex-specific HR narrowed but remained significant (UK NVR: HR 0.83 [0.79-0.88], p < 0.001; SE NPR: HR 0.83 [0.76-0.89], p < 0.001). For OAR, the rate of alive hospital discharge was 23-27% lower for women (UK NVR: HR 0.73 [0.67-0.78], p < 0.001; SE NPR: HR 0.77 [0.70-0.85], p < 0.001). Following adjustment, the sex-specific HR narrowed (UK NVR: HR 0.82 [0.76-0.88], p < 0.001; SE NPR: HR 0.79 [0.72-0.88], p < 0.001) but remained significant.
Conclusions:
The authors report that women have a 25% lower rate of alive discharge after aortic surgery, despite adjustment for pre/peri- and postoperative parameters.
Perspective:
This study reports that women stayed longer in the hospital after aortic repair (consistent for both EVAR and OAR) as well as experienced a higher in-hospital mortality rate. Furthermore, this sex-specific difference narrows slightly but remains significant despite adjustment for age, comorbidities, anatomical complexity, anesthetic, year, standard-of-care, and postoperative complications. There is an urgent need for efforts to increase the rate of alive hospital discharge for women after aortic repair. Further research is also needed to explore the role of gender and social support networks that might impact the rate of alive hospital discharge in the AAA population.
Clinical Topics: Vascular Medicine, Aortic Surgery
Keywords: Aortic Aneurysm, Abdominal, Endovascular Procedures, Sex Characteristics
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