Sex differences in outcomes among adults undergoing abdominal aortic aneurysm repair.
Academic Article
Overview
abstract
OBJECTIVE: While the differences in short-term outcomes between males and females in abdominal aortic aneurysm (AAA) repair have been well studied, it remains unclear if these sex disparities extend to other long-term adverse outcomes after AAA repair, such as reintervention and late rupture. METHODS: We performed a retrospective cohort study of 13,007 patients undergoing either endovascular (EVAR) or open AAA repair (OAR) between 2003-2015 using data from the Vascular Quality Initiative registries. Eligible patients were linked to fee-for-service Medicare claims to identify late outcomes of rupture and aneurysm-specific reintervention. RESULTS: The mean age of our cohort was 76 ± 6.7 years, 22% were females, 94% were white, and 77% underwent EVAR. The 10-year rupture incidence was slightly higher for females at 4.8 per 1000 person-years, versus 3.9 for males, but this difference was not statistically significant after risk adjustment (HR=1.13, 95% CI:0.74-1.73). Likewise, we found no sex difference in reintervention rates (5.1 versus 4.8 in females per 1000 person-years) even after risk adjustment (HR=0.95, 95% CI:0.83-1.09). Regression models suggest effect modification by repair type for reintervention, where females who underwent index EVAR had a higher risk of reintervention than males (HR=1.08, 95% CI:0.93-1.26), while females who underwent OAR were at a lower risk of reintervention compared to males (HR=0.79, 95% CI: 0.58-1.08); however, neither effect reached statistical significance within each subgroup. Additionally, we found that the risk of reintervention for females versus males varied by clinical presentation, where females were less likely to undergo reintervention after an elective or symptomatic AAA repair but were more likely to undergo reintervention after a repair for AAA rupture (HR=1.70, 95% CI: 1.05-2.75). CONCLUSIONS: Males and females undergoing AAA repair had similar rates of reintervention and late aneurysm rupture in the 10 years following their procedure. However, our findings suggest that repair type and clinical presentation may affect the role of sex in clinical outcomes and warrants further exploration in these subgroups.
