Editor's Choice - Sex Related Differences in Peri-operative Mortality after Elective Repair of an Asymptomatic Abdominal Aortic Aneurysm in the Netherlands: a Retrospective Analysis of 2013 to 2018

Eur J Vasc Endovasc Surg. 2019 Dec;58(6):813-820. doi: 10.1016/j.ejvs.2019.05.017. Epub 2019 Nov 6.

Abstract

Objective: The aim was to compare peri-operative (30 day and/or in hospital) mortality between women and men in the Netherlands after elective repair of an asymptomatic abdominal aortic aneurysm (AAA).

Methods: This was a retrospective study using data from the Dutch Surgical Aneurysm Audit (DSAA), a mandatory nationwide registry of patients undergoing AAA repair in the Netherlands. Patients who underwent elective open surgical (OSR) or endovascular aneurysm repair (EVAR) of an asymptomatic abdominal aortic aneurysm (AAA) between 2013 and 2018 were included. Absolute risk differences (ARDs) with 95% confidence intervals (CIs) in peri-operative mortality between women and men were estimated. Logistic regression analyses were performed to estimate adjusted odds ratios (ORs) for mortality. Confounders included pre-operative cardiac and pulmonary comorbidity, serum haemoglobin, serum creatinine, type of AAA repair, and AAA diameter.

Results: Some 1662 women and 9637 men were included, of whom 507 (30.5%) women and 2056 (21.3%) men underwent OSR (p < .001). Crude peri-operative mortality was 3.01% in women and 1.60% in men (ARD = 1.41%, 95% CI 0.64-2.37). This significant difference was also observed for OSR (ARD = 2.63%, 95% CI 0.43-5.36), but not for EVAR (ARD = 0.36%, 95% CI -0.16 to 1.17). Female sex remained associated with peri-operative mortality after adjusting for confounders (OR = 1.79, 95% CI 1.20-2.65, p = .004), which was similarly observed for OSR (OR = 1.85, 95% CI 1.16-2.94, p = .01), but not for EVAR (OR = 1.46, 95% CI 0.72-2.95, p = .29).

Conclusions: Peri-operative mortality after elective repair of an asymptomatic AAA in the Netherlands is higher in women than in men. This disparity might be explained by the higher peri-operative mortality in women undergoing OSR, because no such difference was found in patients undergoing EVAR. Yet, it is likely that there are unaccounted factors at play since female sex remained significantly associated with mortality after adjusting for type of repair.

Keywords: Abdominal; Aortic aneurysm; Elective repair; Mortality; Sex.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aorta, Abdominal / transplantation
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Rupture
  • Asymptomatic Diseases / mortality
  • Asymptomatic Diseases / therapy
  • Elective Surgical Procedures / adverse effects*
  • Elective Surgical Procedures / methods
  • Endovascular Procedures / adverse effects*
  • Endovascular Procedures / methods
  • Female
  • Health Status Disparities
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Patient Selection
  • Perioperative Period / statistics & numerical data*
  • Registries / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • Sex Factors
  • Treatment Outcome
  • Vascular Grafting / adverse effects*
  • Vascular Grafting / methods