Sex Specific Outcomes In Fenestrated Graft Endovascular Aneurysm Repair
Jacob Hubbuch, B.S., Abagail Clark, M.D., Daniel Davenport, Ph.D., Nathan Orr, M.D..
University of Kentucky College of Medicine, Lexington, KY, USA.
OBJECTIVES: It is well established that women have less favorable outcomes when compared to men after abdominal aortic aneurysm (AAA) repair, especially after endovascular aortic repair (EVAR). Fenestrated endovascular aortic repair (FEVAR) is an emerging technique for surgical treatment of juxtarenal AAAs. Currently, little data exists distinguishing sex-specific outcomes after FEVAR. The goal of this study was to compare 30-day outcomes after FEVAR between men and women. METHODS: A retrospective review of data from the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) was performed. Non-emergent, asymptomatic, and non-ruptured EVAR cases which utilized the Cook Zenith Fenestrated main body device were selected for analysis. Preoperative patient characteristics, aneurysm and intraoperative data, and post-operative 30-day outcomes were compared between men and women using chi-square, Fisher’s exact, or Kruskal-Wallis tests with significance set at p<0.05.
RESULTS: A total of 309 patients underwent FEVAR with 52 (16.8%) of the patients being women. Men and women underwent the procedure at a similar age (73.8 years vs 76.1 years; p=0.076) with the average age being 74.2 (SD=8.5) years. Preoperatively, men and women had similar ASA classifications, BMIs, smoking statuses, and incidences of diabetes, COPD, congestive heart failure, and renal failure. The average aneurysm diameter was 5.9 (SD=1.0) centimeters with no significant difference between diameters (5.9 cm vs 4.9 cm; p=0.297), proximal aneurysm extent, and distal aneurysm extent between the two sexes. Women had longer operations (236 minutes vs 306 minutes; p<0.001) and were more likely to receive a blood transfusion within 72 hours of incision (21.8% vs 38.5%; p=0.014). Return to the OR (4.3% vs 13.5%; p=0.018), 30-day mortality (0.8% vs 5.8%; p=0.035), and 30-day morbidity (15.6% vs 28.8%; p=0.029) were higher in women; however, when evaluated separately, there were no significant differences in specific cardiac, pulmonary, renal or infectious complications.
CONCLUSIONS: Overall, women were more likely to experience complications after FEVAR for AAA, in addition to having an increased risk of returning to the OR and death within 30-days, when compared to men. Longer-term outcome studies will be useful to further delineate sex-based outcome discrepancies.
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