Back to 2016 Annual Symposium Abstacts

OBJECTIVES:
Medicare studies have shown increased perioperative mortality in women compared to men following endovascular and open AAA repair. However, a recent regional study of high-volume centers did not show sex to be predictive of worse outcomes. This study aims to evaluate sex differences after intact AAA repair in a national clinical registry of centers interested in vascular quality improvement.
METHODS:
The Targeted Vascular module of NSQIP was queried to identify patients undergoing EVAR or open repair for intact, infrarenal AAA from 2011-2013. Statistical analysis was performed using the chi square test and Student t-test. Multivariable logistic regression was performed to account for differences in comorbidities, aneurysm details, and operative characteristics.
RESULTS:
We identified 4,548 patients (19.6% women) who underwent AAA repair (85.9% EVAR, women 81.7% and men 86.9%, P < .001). Women were older (76.0 vs. 73.2, P < .001), had smaller aneurysms (5.56cm ± 1.08 vs. 5.82cm ± 1.30, P < .001), and more had COPD (24.4% vs. 16.5%, P < .001). Amongst patients undergoing EVAR, women had longer operative times (138 minutes [IQR 103-170] vs. 131 [106-181], P = 0.006) and more often underwent renal (6.3% vs. 4.1%, P = 0.008) and lower extremity revascularization (6.6% vs. 3.8%, P = 0.002). After open repair, there was no difference in operative time (219 vs. 229 minutes, P = 0.107), but women less frequently underwent lower extremity revascularization (3.1% vs. 8.2%, P = 0.026). Thirty-day mortality was higher in women after EVAR (3.2% vs. 1.2%, P < .001) and open repair (8.0% vs. 4.0%, P = 0.043). After adjusting for repair type, age, aneurysm diameter, operative time, and comorbidities, female sex independently predicted mortality (odds ratio [OR] 2.1, 95% confidence interval [CI]: 1.3-3.4, P = 0.003) and major complications (OR 1.7, CI: 1.4-2.2, P = <.001) after intact AAA repair.
CONCLUSIONS:
Previous studies have disagreed on the effect of sex on mortality and morbidity associated with AAA repair. Our study, in contrast to prior regional clinical data, showed female sex to be independently predictive of 30-day mortality and major complications after intact AAA repair.

Table 1. Unadjusted outcomes by sex following EVAR and open AAA repair

Outcome Number (%)	EVAR Female Sex N=729	Male Sex N=3,178	P-value	Open Female Sex N=163	Male Sex N=478	P-value
30-Day Mortality	23 (3.2)	38 (1.2)	<.001	13 (8.0)	19 (4.0)	0.043
Major Complications	92 (12.6)	234 (7.4)	<.001	48 (29.4)	115 (24.1)	0.172
Myocardial Infarction	13 (1.8)	41 (1.3)	0.304	3 (1.8)	10 (2.1)	1
Pulmonary Complications	23 (3.2)	69 (2.2)	0.114	40 (24.5)	68 (14.2)	0.002
Renal Complications	23 (3.2)	69 (2.2)	0.114	40 (24.5)	68 (14.2)	0.002
Stroke	7 (1.0)	3 (0.1)	<.001	2 (1.2)	0 (0)	0.064
Ischemic Colitis	4 (0.5)	14 (0.4)	0.697	6 (3.7)	12 (2.5)	0.419
Lower Extremity Ischemia	17 (2.3)	35 (1.1)	0.009	2 (1.2)	14 (2.9)	0.382
Length of Stay, Median (IQR)	2 (1-4)	1 (1-2)	<.001	7 (6-10)	6 (5-9)	0.013