A Rutgers study underscores the need for greater focus on including women in aneurysm screening, device design, and clinical trials.
Aim
Although sex differences in outcomes of endovascular abdominal aortic aneurysm repair (EVAR) have been increasingly reported, determination of contributing factors has not reached consensus.
We investigated sex-specific outcome disparities after elective EVAR at our institution and evaluated factors that might predispose women to increased morbidity and mortality.
Methods
We performed a retrospective chart review of all patients who had undergone elective EVAR between 2011 and 2020 at a suburban tertiary care center. The primary outcomes were 5-year survival and freedom from reintervention.
Fisher’s exact test, t tests, and Kaplan-Meier analysis using the log-rank test were used to investigate associations between sex and outcomes. A multivariable Cox proportional hazards model controlling for age and common comorbidities assessed the effect of sex on survival and freedom from reintervention.
Results
A total of 273 patients had undergone elective EVAR during the study period, including 68 women (25%) and 205 men (75%).
Women were older on average than men (76 years vs 73 years ; p ≤ 0.01) and were more likely to have chronic obstructive pulmonary disease (38% vs 23%; p = 0.01), require oxygen therapy home (9% vs 2%; P = 0.04), or preoperative dialysis (4% vs 0%; P = 0.02). The distribution of other common vascular comorbidities was similar between sexes.
The 30-day readmission rate was higher for women than men (18% vs. 8%; P = 0.02).
Women had significantly shorter survival at 5 years (48% ± 7.9% vs. 65% ± 4.3%; P < 0.01) and significantly shorter survival at 1 year (women, 89% ± 4.3%; P < 0.01). 1%; vs. men, 94% ± 1.7%; p = 0.01) and 5 years (women, 69% ± 8.9%; vs. men, 84% ± 3.3%; p = 0 .02) free of reintervention.
In multivariable analysis, female sex (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.1-2.9), congestive heart failure (HR, 2.2; 95% CI) %, 1.2-3.9) and older age (HR, 1.1; 95% CI, 1.0-1.1) were associated with 5-year mortality.
Female sex remained the only variable with a statistically significant association with reintervention at 5 years (HR, 2.4; 95% CI, 1.1-4.9).
Conclusions
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Comments
Women are more likely to die within five years of having elective surgery to repair a weakening in the aorta wall or need repeat surgery, according to a recent Rutgers study.
Published in the Journal of Vascular Surgery , Rutgers researchers said the disparity between men and women who undergo surgery should be addressed by including women in early aortic aneurysm detection, as well as enrolling more women in trials. aortic medical device clinics.
"Despite the fact that men are more likely to be diagnosed and die from an abdominal aortic aneurysm [AAA], women are still underrepresented in many clinical trials of aortic devices used in minimally invasive aortic aneurysm repair. "said William Beckerman, who led the study and is an assistant professor in the Division of Vascular Surgery and Endovascular Therapy at Rutgers Robert Wood Johnson Medical School.
“Given that men and women are known to have different aortic anatomy, this study highlights the need for greater focus and inclusion of women in the creation of aortic devices and subsequent enrollment in trials.”
An abdominal aortic aneurysm, a condition that led to Albert Einstein’s death in 1955, is life-threatening and common among the elderly. Such aneurysms occur when the abdominal aorta, the main blood vessel that supplies blood to the abdomen, pelvis, and legs, bulges, then ruptures, and finally hemorrhages.
The treatment, a surgery known as endovascular abdominal aortic aneurysm repair (EVAR), focuses on addressing the problem early by inserting fabric-covered metal supports into the damaged aortic vessel of a person to wrap the weak spot before it swells and bursts.
Aortic aneurysms or aortic dissections were the cause of 9,904 deaths in 2019, according to the US Centers for Disease Control and Prevention.
Researchers conducted a retrospective chart review of 273 patients, 75% men and 25% women, who underwent EVAR between 2011 and 2020 at a tertiary medical center, a facility that cares for patients receiving highly specialized medical.
The idea was to find out how many patients survived five years after surgery and how many needed repeat surgeries. Women were older on average than men and were more likely to have chronic obstructive pulmonary disease, require home oxygen therapy or dialysis.
Despite some variations in morbidities, the differences in survival and repeat surgery were statistically significant, the researchers found. Women had significantly lower survival rates at five years, as well as a higher rate of reintervention within those years.
"Our question was, knowing all these things we do, do men and women have different outcomes, even if they are operated on by the same surgeon, in the same hospital with the same devices?" Beckermann said. "The answer to that was ’yes.’ Men and women behave differently after surgery."
“Our data suggest that factors beyond patient age and baseline health risk likely contribute to increased surgical morbidity and mortality for women after elective EVAR,” Beckerman said.
Other Rutgers researchers in the study were division chief Saum Rahimi, along with Robert Wood Johnson Medical School students Taylor Corsi, Michael Ciaramella, Nadia Palte and John Carlson.
