Gender disparities in patients with aortoiliac disease requiring open operative intervention

Megan E Lombardi; Jonathan R Smith; Colby S Ruiz; Deanna M Caruso; Chris B Agala; Katharine L McGinigle; Mark A Farber; Jacob E Wood; William A Marston; F Ezequiel Parodi; Luigi Pascarella

doi:10.1016/j.jvs.2023.07.008

Gender disparities in patients with aortoiliac disease requiring open operative intervention

J Vasc Surg. 2023 Nov;78(5):1278-1285. doi: 10.1016/j.jvs.2023.07.008. Epub 2023 Jul 20.

Affiliations

¹ Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC. Electronic address: megan.lombardi@unchealth.unc.edu.
² University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
³ Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
⁴ Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.

PMID: 37479089
DOI: 10.1016/j.jvs.2023.07.008

Abstract

Objective: Peripheral artery disease is known to affect males and females in different proportions. Disparate surgical outcomes have been quantified after endovascular aortic aneurysm repair, arteriovenous fistula creation, and treatment of critical limb ischemia. The aim of this study is to objectively quantify the sex differences in outcomes in patients undergoing open surgical intervention for aortoiliac occlusive disease.

Methods: Patients were identified in the aortoiliac occlusive disease Vascular Quality Initiative database who underwent aorto-bifemoral bypass or aortic thromboendarterectomy as determined by Current Procedural Terminology codes between 2012 and 2019. Patients with a minimum of 1-year follow-up were included. Risk differences (RDs) by sex were calculated using a binomial regression model in 30-day and 1-year incidence of mortality and limb salvage. Additionally, incidence of surgical complications including prolonged length of stay (>10 days), reoperation, and change in renal function (>0.5 mg/dl rise from baseline), were recorded. Inverse probability weighting was used to standardize demographic and medical history characteristics. Multivariate logistic regression models were employed to conduct analyses of the before mentioned clinical outcomes, controlling for known confounders.

Results: Of 16,218 eligible patients from the VQI data during the study period, 6538 (40.3%) were female. The mean age, body mass index, and race were not statistically different between sexes. Although there was no statistically significant difference detected in mortality between males and females at 30 days postoperatively, females had an increased crude 1-year mortality with an RD of 0.014 (95% confidence interval, 0.01-0.02; P value < .001. Males had a higher rate of a postoperative change in renal function with an RD of -0.02 (95% confidence interval, -0.03 to -0.01; P < .001).

Conclusions: Although there was no sex-based mortality difference at 30 days, there was a statistically significant increase in mortality in females after open aortoiliac intervention at 1 year based on our weighted model. Male patients are statistically significantly more likely to have a decline in renal function after their procedures when compared with females. Postoperative complications including prolonged hospital stay, reoperation, and wound disruption were similar among the sexes, as was limb preservation rates at 1 year. Further studies should focus on elucidating the underlying factors contributing to sex-based differences in clinical outcomes following aortoiliac interventions.

Keywords: Aortoiliac occlusive disease; Gender disparities; Surgery; Vascular surgery.