Sex differences in mortality and morbidity following repair of intact abdominal aortic aneurysms

Deery, Sarah E.; Soden, Peter A.; Zettervall, Sara L.; Shean, Katie E.; Bodewes, Thomas C.F.; Pothof, Alexander B.; Lo, Ruby C.; Schermerhorn, Marc L.

doi:10.1016/j.jvs.2016.08.100

Cited by 123 publications

(108 citation statements)

References 37 publications

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“…A recent study using the English National Health Service (NHS) administrative data set and UK National Vascular Registry data demonstrated that in‐hospital mortality following elective as well as ruptured AAA is worse in women; this confirmed the findings of previous studies that used national databases and registries, and demonstrated higher mortality rates following repair of AAA among women. A recent economic evaluation supported by clinical outcome data from an administrative data set and national registry reported that screening women for AAA is not cost‐effective under various scenarios, including starting screening at an older age.…”

Section: Introductionsupporting

confidence: 74%

Sex differences in national rates of repair of emergency abdominal aortic aneurysm

Aber

Tong

Chilcott

et al. 2019

Journal of British Surgery

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Background The aim of this study was to assess the sex differences in both the rate and type of repair for emergency abdominal aortic aneurysm (AAA) in England. Methods Hospital Episode Statistics (HES) data sets from April 2002 to February 2015 were obtained. Clinical and administrative codes were used to identify patients who underwent primary emergency definitive repair of ruptured or intact AAA, and patients with a diagnosis of AAA who died in hospital without repair. These three groups included all patients with a primary AAA who presented as an emergency. Sex differences between repair rates and type of surgery (endovascular aneurysm repair (EVAR) versus open repair) over time were examined. Results In total, 15 717 patients (83·3 per cent men) received emergency surgical intervention for ruptured AAA and 10 276 (81·2 per cent men) for intact AAA; 12 767 (62·0 per cent men) died in hospital without attempted repair. The unadjusted odds ratio for no repair in women versus men was 2·88 (95 per cent c.i. 2·75 to 3·02). Women undergoing repair of ruptured AAA were older and had a higher in‐hospital mortality rate (50·0 versus 41·0 per cent for open repair; 30·9 versus 23·5 per cent for EVAR). After adjustment for age, deprivation and co‐morbidities, the odds ratio for no repair in women versus men was 1·34 (1·28 to 1·40). The in‐hospital mortality rate after emergency repair of an intact AAA was also higher among women. Conclusion Women who present as an emergency with an AAA are less likely to undergo repair than men. Although some of this can be explained by differences in age and co‐morbidities, the differences persist after case‐mix adjustment.

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Section: Introductionsupporting

confidence: 74%

Sex differences in national rates of repair of emergency abdominal aortic aneurysm

Aber

Tong

Chilcott

et al. 2019

Journal of British Surgery

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“…However, this sex difference was not noted at 5 years. Although previous studies 33,34 highlighted the higher initial perioperative mortality in women, the 5-year mortality did not confirm this 34,35 . This is possibly due to other competing factors, including increasing age, co-morbidities and type of repair, in line with other studies 36 .…”

Section: Discussionmentioning

confidence: 66%

Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden

Karthikesalingam

Grima

Holt

et al. 2018

British Journal of Surgery

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BackgroundThere is substantial international variation in mortality after abdominal aortic aneurysm (AAA) repair; many non‐operative factors influence risk‐adjusted outcomes. This study compared 90‐day and 5‐year mortality for patients undergoing elective AAA repair in England and Sweden.MethodsPatients were identified from English Hospital Episode Statistics and the Swedish Vascular Registry between 2003 and 2012. Ninety‐day mortality and 5‐year survival were compared after adjustment for age and sex. Separate within‐country analyses were performed to examine the impact of co‐morbidity, hospital teaching status and hospital annual caseload.ResultsThe study included 36 249 patients who had AAA treatment in England, with a median age of 74 (i.q.r. 69–79) years, of whom 87·2 per cent were men. There were 7806 patients treated for AAA in Sweden, with a median of age 73 (68–78) years, of whom 82·9 per cent were men. Ninety‐day mortality rates were poorer in England than in Sweden (5·0 versus 3·9 per cent respectively; P < 0·001), but were not significantly different after 2007. Five‐year survival was poorer in England (70·5 versus 72·8 per cent; P < 0·001). Use of EVAR was initially lower in England, but surpassed that in Sweden after 2010. In both countries, poor outcome was associated with increased age. In England, institutions with higher operative annual volume had lower mortality rates.ConclusionMortality for elective AAA repair was initially poorer in England than Sweden, but improved over time alongside greater uptake of EVAR, and now there is no difference. Centres performing a greater proportion of EVAR procedures achieved better results in England.

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“…A retrospective cohort study 36 These studies have several limitations. First and foremost, factors that might confound the comparison of men and women, such as age, aneurysm diameter, and comorbidities, were inconsistently reported.…”

Section: Schermerhorn Et Al (2012) 30mentioning

confidence: 99%

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Ulug¹,

Sweeting²,

vonAllmen³

et al. 2017

Journal of Vascular Surgery

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1 ArticlesMorphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis Pinar Ulug, Michael J Sweeting, Regula S von Allmen, Simon G Thompson, Janet T Powell, on behalf of the SWAN collaborators* Summary Background Prognosis for women with abdominal aortic aneurysm might be worse than the prognosis for men. We aimed to systematically quantify the differences in outcomes between men and women being assessed for repair of intact abdominal aortic aneurysm using data from study periods after the year 2000.Methods In these systematic reviews and meta-analysis, we identified studies (randomised, cohort, or cross-sectional) by searching MEDLINE, Embase, CENTRAL, and grey literature published between Jan 1, 2005, and Sept 2, 2016, for two systematic reviews and Jan 1, 2009, and Sept 2, 2016, for one systematic review. Studies were included if they were of both men and women, with data presented for each sex separately, with abdominal aortic aneurysms being assessed for aneurysm repair by either endovascular repair (EVAR) or open repair. We conducted three reviews based on whether studies reported the proportion morphologically suitable (within manufacturers' instructions for use) for EVAR (EVAR suitability review), non-intervention rates (non-intervention review), and 30-day mortality (operative mortality review) after intact aneurysm repair. Studies had to include at least 20 women (for the EVAR suitability review), 20 women (for the non-intervention review), and 50 women (for the operative mortality review). Studies were excluded if they were review articles, editorials, letters, or case reports. For the operative review, studies were also excluded if they only provided hazard ratios or only reported in-hospital mortality. We assessed the quality of the studies using the NewcastleOttawa scoring system, and contacted authors for the provision of additional data if needed. We combined results across studies by random-effects meta-analysis. This study is registered with PROSPERO, number CRD42016043227.Findings Five studies assessed the morphological eligibility for EVAR (1507 men, 400 women). The overall pooled proportion of women eligible (34%) for EVAR was lower than it was in men (54%; odds ratio [OR] 0·44, 95% CI 0·32-0·62). Four single-centre studies reported non-intervention rates (1365 men, 247 women). The overall pooled non-intervention rates were higher in women (34%) than men (19%; OR 2·27, 95% CI 1·21-4·23). The review of 30-day mortality included nine studies (52 018 men, 11 076 women). The overall pooled estimate for EVAR was higher in women (2·3%) than in men (1·4%; OR 1·67, 95% CI 1·38-2·04). The overall estimate for open repair also was higher in women (5·4%) than in men (2·8%; OR 1·76, 95% CI 1·35-2·30).Interpretation Compared with men, a smaller proportion of women are eligible for EVAR, a higher proportion of women are not offered intervention, and operative...

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Sex differences in mortality and morbidity following repair of intact abdominal aortic aneurysms

Cited by 123 publications

References 37 publications

Sex differences in national rates of repair of emergency abdominal aortic aneurysm

Sex differences in national rates of repair of emergency abdominal aortic aneurysm

Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

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