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Women have worse 30-day outcomes than men after intact AAA repair
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Among patients undergoing endovascular or surgical repair of an intact abdominal aortic aneurysm, women have greater risk for 30-day mortality and major complications compared with men, researchers found.
The researchers analyzed 6,661 patients (19% women) included in the targeted vascular module of the National Surgical Quality Improvement Program who underwent endovascular or open repair for an intact AAA between 2011 and 2014. They compared 30-day outcomes by sex.
At baseline, compared with men, women were older (median age, 76 years vs. 73 years; P < .001), had smaller aneurysms (median, 5.4 cm vs. 5.5 cm; P < .001) and were more likely to have chronic obstructive pulmonary disease (22% vs. 17%; P < .001), according to the researchers.
Among those who had endovascular repair (EVAR), compared with men, women had longer operating times (median, 138 minutes vs. 131 minutes) and were more likely to require renal revascularization (6.3% vs. 4.1%; P < .01) or lower-extremity revascularization (6.6% vs. 3.8%; P < .01), Sarah E. Deery, MD, from the division of vascular and endovascular surgery at Beth Israel Deaconess Hospital, Boston, and the department of surgery at Massachusetts General Hospital and Harvard Medical School, and colleagues wrote.
Among those who had open repair, compared with men, women had shorter operating time (median, 215 minutes vs. 226 minutes, P = .02) and were less likely to require lower-extremity revascularization (3.1% vs. 8.2%; P = .03), the researchers wrote.
Women had higher 30-day mortality than men regardless of whether they underwent EVAR (3.2% vs. 1.2%; P < .001) or open repair (8% vs. 4%; P = .04), Deery and colleagues found.
When the researchers adjusted for repair type, age, aneurysm diameter and comorbidities, female sex was independently associated with mortality (OR = 1.7; 95% CI, 1.1-2.6) and major complications (OR = 1.4; 95% CI, 1.1-1.7).
However, the association was attenuated when the researchers adjusted for aortic size index instead of aneurysm diameter (mortality OR = 1.5; 95% CI, 0.98-2.4; major complications OR = 1.1; 95% CI, 0.9-1.4).
“[Aortic size index] may be a better indicator for threshold for AAA repair for female patients,” Deery and colleagues wrote. “Further studies to evaluate the exact [aortic size index] threshold for intervention are necessary to implement this method clinically.” – by Erik Swain
Disclosure: One researcher reports receiving consultant fees from Endologix and Medtronic.
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