Effects of Gender Differences on Short-term Outcomes in Patients with Type B Aortic Dissection

Abstract

Introduction Gender-related differences in type B aortic dissection (TBAD) presentation and outcomes are not well understood. The objective of this study is to assess the impact of gender on short-term outcomes in patients with TBAD. Methods Patients with TBAD were identified from National Inpatient Sample datasets from 2009–2012 according to previously published methods. The primary outcomes of interest were in-hospital mortality and major complications (renal, cardiac, pulmonary, paraplegia, and stroke-related) between men and women. An inverse propensity-weighted regression was used to balance comorbid and clinical presentation differences. Subgroup analyses were performed on those undergoing endovascular (TEVAR) and open repair, and for elderly patients over the age of 70. Results We identified 9855 patients with TBAD; females were fewer (43.6%, n=4293), and presented at a later age (69.8±15.5 vs. 62.8±15.6, p<0.001). Females had more comorbidities (median Elixhauser 4 [IQR 2–5] vs. 3 [IQR 2–5], p<0.001), and were more often managed non-operatively (87.4% vs. 81.8%, p<0.001) compared to males. For those undergoing intervention, 58% (n=903) had open repair and TEVAR rates were higher in females compared to males (45.6% vs. 40.0%, p<0.001). Unadjusted mortality rates did not differ significantly by gender (male: 11.6% vs. female: 10.7%). In an adjusted propensity-weighted regression, gender did not significantly affect in-hospital mortality or stroke rates, but females were less likely to have acute renal failure during their hospitalization and more likely to experience cardiac events when undergoing open repair. Elderly females were also less likely to experience acute renal failure but had higher odds of cardiac events regardless of intervention compared to elderly men. Conclusions In comparison to men, females with TBAD presented at a later age, were more likely to undergo TEVAR, sustain a perioperative cardiac event with open surgery, and less likely to experience acute renal complications overall. Elderly females were additionally more likely to sustain a cardiac event regardless of operative status. Future studies should attempt to identify anatomic and epidemiologic reasons for these differences.

Gender Difference is Associated with Short-Term Outcomes in Non-Surgically Managed Acute Aortic Dissection Patients with Hypertension: A Retrospective Cohort Study

“…Females tended to be older and generally more chronically ill, with higher rates of diabetes. 13 Though there is no significant statistics difference of age in different genders, females were older and more likely to present with atypical pain than males in our study. Differences in inhabit, phenotype, diet, and customs between Western and Chinese populations might also affect treatment outcomes.…”

“… 12 An observational study of 9855 type B AAD patients indicated that compared with men, women were more likely to experience endovascular and sustain a perioperative cardiac event with open surgery. 13 In Chinese with AAD, gender is also not independently related to long‑term clinical outcomes. 14 Our study may have a better assessment of gender-related short-term outcomes disparity.…”

Consideration of Sex Differences in Design and Reporting of Experimental Arterial Pathology Studies—Statement From ATVB Council

“…Recent data indicate that women are more likely to undergo thoracic endovascular aortic repair than open repair, and have a higher mortality and lower long- term survival after surgery. 71,72…”

Are outcomes of thoracoabdominal aortic aneurysm repair different in men versus women? A propensity-matched comparison

“…There was little difference in early outcomes in the matched groups; pulmonary complications were more common in women, and persistent paraplegia was slightly more common in men. By using National Inpatient Sample data on 9855 open and endovascular repairs of acute distal aortic dissection, Liang and colleagues 34 found higher rates of postoperative paraplegia in men than in women after propensity weighting.…”