Sex-based Differences in Survival After Repair of Ruptured Abdominal Aortic Aneurysm

Abstract

We have described the sex-based differences in survival after repair of ruptured abdominal aortic aneurysms (rAAAs). We performed a single-center retrospective review of data from the institutional Clinical Research Data Warehouse. Adults who had undergone either open surgery (OS) or endovascular aneurysm repair (EVAR) for rAAAs between January 1996 and December 2018 were included in the present study. Patients whose EVAR was converted to OS were included in the OS group. Patients with untreated rAAAs, rAAAs treated at an outside hospital, or ruptured thoracic or thoracoabdominal aortic aneurysms were excluded. The primary outcome was survival. The secondary outcomes included mode of repair, postoperative complications, and discharge disposition. We identified 193 patients (20.7% women) who had undergone rAAA repair (35.2% EVAR). No significant association was found between sex and mode of repair. The 1- and 5-year survival was 32.5% and 29.8% for the women and 55.8% and 40.8% for the men, respectively (P = .001). The 1- and 5-year survival stratified by sex and mode of repair was EVAR and male sex, 69% and 50.7%; OS and male sex, 48% and 35.8%; EVAR and female sex, 45.5% and 34.1%; and OS and female sex, 27.6% and 27.6%, respectively (P = .002; Fig). Multivariable analysis showed that men undergoing OS had lower mortality compared with women undergoing OS (adjusted hazard ratio, 0.51; 95% confidence interval, 0.32-0.81; P = .04). No difference was found in mortality between the men and women undergoing EVAR, between the women undergoing EVAR and the women undergoing OS, and between the men undergoing EVAR and the men undergoing OS (Table). The men undergoing OS had a greater incidence of renal failure requiring renal replacement therapy (29.9%; P = .026), bowel ischemia (23.3%; P < .001), and pneumonia (28.9%; P = .022) compared with the other groups. The men undergoing EVAR had a greater incidence of urinary tract infection (9.3%; P = .037), and the women undergoing OS had a greater incidence of prolonged intubation (66.7%; P < .001) compared with the other groups. Fewer women were discharged to home (10.0% vs 39.9%; P < .001) and more were discharged to hospice or had died compared with the men (60.0% vs 32.7%; P = .002). No difference was found in the rates of discharge to a rehabilitation facility for the men and women. OS for men was associated with lower mortality compared with OS for women for treatment of rAAAs. No difference was found in the mortality of men and women who had undergone EVAR for rAAAs. OS for the men with a rAAA was associated with more complications compared with the other groups. The women were less likely to be discharged home and were more likely to be discharged to hospice care or to have died after rAAA repair.Table IMultivariable regression model showing adjusted hazard ratio stratified by group and age category (n = 193; events, n = 137)VariableaHR95% CIP valueGroup.027 EVAR female vs OS male1.770.79-3.96.162 OS female vs OS male1.961.23-3.11.004 EVAR male vs OS male1.000.61-1.62.992Age ≥70 vs <70 years1.791.19-2.68.005Aneurysm position.045 Juxtarenal vs infrarenal1.520.96-2.39.074 Suprarenal vs infrarenal3.971.36-11.58.012 Missing vs infrarenal2.080.79-5.43.136Transferred (yes vs no)0.670.46-0.96.028Type of rupture (free vs contained)1.891.08-3.31.025Previous known history of aneurysm (yes vs no or NR)1.541.05-2.25.028aHR, adjusted hazard ratio; CI, confidence interval; EVAR, endovascular aneurysm repair; NR, not reported; OS, open surgery. Open table in a new tab