Abstract
Objective: Peripheral artery disease (PAD) is a common atherosclerotic disease associated with increased morbidity and mortality. We conducted a retrospective review to investigate the role of gender in influencing the incidence of stroke after surgery for PAD. Methods: We conducted a retrospective review using data from the Vascular Quality Initiative database for patients who underwent supra-inguinal and infra-inguinal surgery between 2010 and 2020. The relationship between gender and 30-day post-operative outcomes was calculated as an odds ratio; the threshold of significance was p =0.05 for univariate and multivariable analysis. Gender-based influence of age and adjusted probability of stroke was plotted using Sigma Plot. Results: A total of 79,981 patients were included based on our eligibility criteria, 34% of which were female. Although only 0.6% of patients experienced stroke, risk of stroke was significantly higher in female patients ( p <0.001). Female patients were more commonly hypertensive ( p =0.007) and diabetic ( p =0.003), while also presenting decreased pre-operative use of statin ( p <0.001) and aspirin ( p <0.001) as compared to males. Additional predictors of post-operative stroke include age > 65 years ( p =0.015), hypertension ( p =0.002), and pre-operative use of beta blockers ( p <0.001). Overall, females had higher risk of all-cause morbidity ( p =0.004), stroke ( p <0.001), mortality ( p <0.001), and major adverse cardiovascular events ( p <0.001), while males had increased risk of returning to the operating room ( p =0.006). Regression analysis revealed a significantly stronger bearing of high age on probability of post-operative stroke in women ( p <0.001). Conclusion: Our data suggests that incidence of post-operative stroke and other cardiovascular complications is influenced by gender in surgery of PAD. Future research investigating underlying gender-based mechanisms is necessary to personalize treatment in patients with PAD.
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