K. Tabibian1, D. Yalzadeh1, N. Le1, O. Kwon1,2, E. Aguayo1,2, A. Chaturvedi1, S. Mallick1, E. Elkins1, P. Benharash1,3 1Center For Advanced Surgical & Interventional Technology (CASIT), David Geffen School Of Medicine, University Of California At Los Angeles, Los Angeles, CA, USA 2Department Of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA 3Department Of Surgery, David Geffen School Of Medicine, University Of California At Los Angeles, Los Angeles, CA, USA
Introduction: While endovascular aneurysm repair (EVAR) is widely adopted for the treatment of abdominal aortic aneurysms, several factors, including female sex, have traditionally been thought to confer inferior outcomes. In the absence of contemporary analyses, we characterized in-hospital outcomes of EVAR in a national cohort of patients with abdominal aortic aneurysms and examined the evolution of sex-based disparities over a 12-year period.
Methods: The 2010-2021 Nationwide Readmissions Database was queried to identify all adult (≥18 years) patients with a diagnosis of abdominal aortic aneurysm undergoing EVAR. Those presenting with ruptured and traumatic aneurysms were not included. The primary outcome was in-hospital mortality. Secondary outcomes included perioperative complications and 30-day non-elective readmissions. Multivariable regression models and marginal analysis were employed to examine associations of sex with outcomes of interest.
Results: Of an estimated 148,439 patients undergoing EVAR, 30,174 (20.3%) were female. During the study period, the proportion of EVAR performed on female patients increased from 19.4% to 21.4% (nptrend < 0.001). Female patients were older (76 [69-81] vs. 73 years [67-79], p < 0.001), had a higher Elixhauser Comorbidity Index (4 [2-5] vs. 3 [2-4], p < 0.001), and less frequently underwent elective procedures (79.6% vs. 83.2%, p < 0.001). Following multivariable adjustment, female sex was associated with increased odds of in-hospital mortality (AOR: 1.88, 95% CI: 1.64-2.16). In the analysis of trends, risk-adjusted rates of mortality remained higher for female patients compared to their male counterparts, despite improvements over the study duration (Figure 1). Additionally, female patients were more likely to experience unplanned 30-day readmissions (AOR: 2.20, 95% CI: 1.23-3.93) and overall perioperative complications (AOR: 1.53, 95% CI: 1.45-1.60). Specifically, female sex was independently associated with higher stroke (AOR: 1.37, 95% CI: 1.17-1.60), thromboembolic (AOR: 1.20, 95% CI: 1.02-1.42), respiratory (AOR: 1.50, 95% CI: 1.39-1.61), infectious (AOR: 1.75, 95% CI: 1.60-1.91), and acute renal failure complications (AOR: 1.44, 95% CI: 1.08-1.94), as well as acute lower limb ischemia requiring revascularization (AOR: 1.89, 95% CI: 1.75-2.04).
Conclusion: Over a 12-year period, female patients undergoing EVAR faced higher rates of mortality, complications, and readmissions as compared to males. While the differences in outcomes between males and females decreased, future interventions should aim to further mitigate the disparities noted in clinical outcomes.