Sex-based disparities in acute outcomes of endovascular abdominal aortic aneurysm repair.

Abstract

Although endovascular aneurysm repair is widely adopted for the treatment of abdominal aortic aneurysms, several factors, including female sex, traditionally have been thought to confer inferior outcomes. In the absence of contemporary analyses, we characterized in-hospital outcomes of endovascular aneurysm repair in a national cohort of patients with abdominal aortic aneurysm and examined the evolution of sex-based disparities over the past decade. The 2010-2021 Nationwide Readmissions Database was queried to identify all adult (≥18 years) patients with a diagnosis of unruptured abdominal aortic aneurysms undergoing elective endovascular aneurysm repair. The primary outcome was in-hospital mortality. Secondary end points included perioperative complications and 30-day nonelective readmissions. Multivariable regression models and marginal analysis were employed to examine associations of sex with outcomes of interest. Of an estimated 243,025 patients undergoing endovascular aneurysm repair, 46,360 (19.1%) were female. During the study period, the proportion of female patients undergoing endovascular aneurysm repair as compared with open surgery for the treatment of unruptured abdominal aortic aneurysms increased from 71.1% to 82.8% (nptrend < 0.05). After multivariable adjustment, female sex was associated with increased odds of in-hospital mortality (adjusted odds ratio; 2.74; 95% confidence interval, 2.22-3.39), nonhome discharge (adjusted odds ratio, 2.27; 95% confidence interval, 2.07-2.48), and an additional $1,330 in costs (95% confidence interval, $1,000-$1,660). In the analysis of trends, risk-adjusted rates of mortality remained greater for female patients compared with their male counterparts, despite improvements over the study duration. Over the past decade, female patients undergoing endovascular aneurysm repair faced greater rates of mortality, complications, and readmissions as compared with male patients. Future interventions should aim to further mitigate the disparities noted in clinical outcomes.