Abstract 12937: Sex Differences on Clinical Outcomes After Thoracic Endovascular Aortic Repair

Abstract

Introduction: Thoracic endovascular aortic repair (TEVAR) has been increasingly utilized for the treatment of descending thoracic aortic aneurysms and dissections. Further research is warranted to understand outcomes of TEVAR in various populations. Hypothesis: Sex will not influence outcomes after nonelective TEVAR. Methods: This was an observational study from the Nationwide Readmissions Database analyzing men (n=3903) and women (n=2691) with aortic aneurysm or Type B aortic dissection who underwent nonelective TEVAR from 2010-2017. Appropriate trend weighting was used to generate national estimates. International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes were used to identify patients with thoracic aortic aneurysms or dissections who underwent TEVAR. 30-day and 90-day readmissions, in-hospital mortality, postoperative complications, and cost were compared between the two groups. Mixed model logistic regression was used to determine predictors of readmission, treating each participating hospital as a random effect. Results: The study population consisted of 6594 patients (3903 men, 2691 women) who underwent nonelective TEVAR. In-hospital mortality was 9.3% (n=613) and was not significantly different between groups (9.85% in men vs 8.50% in women, p=0.06). Of the remaining 5981 patients, women were more likely than men to be older, to have chronic pulmonary disease, and to have aneurysm rather than dissection as their indication for TEVAR. Women were less likely to have chronic kidney disease. Postoperatively, women were less likely to develop respiratory failure (9.41% vs 11.75%), acute kidney injury (17.93% vs 33.87%), and mesenteric ischemia (2.63% vs 4.36%). On multivariable regression, female sex was not associated with an increased risk of readmission at 30 days (OR 1.04, 95% CI 0.87-1.25, p=0.67) or 90 days (OR 1.06, 95% CI 0.90-1.25, p=0.48) as compared to male sex. Conclusions: Sex was not an independent predictor of 30-day and 90-day readmissions after nonelective TEVAR. While males had higher rates of complications such as acute kidney injury and mesenteric ischemia, mortality did not differ significantly between the two groups.