Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): An analysis using the ACS NSQIP dataset

Abedi, Nick; Davenport, Daniel L.; Xenos, Eleftherios S.; Sorial, Ehab; Minion, David J.; Endean, Eric D.

doi:10.1016/j.jvs.2009.04.047

Cited by 122 publications

(101 citation statements)

References 14 publications

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“…Similarly, Abedi et al 23. described higher mortality rates in women following elective EVAR (3·4 versus 2·1 per cent; P = 0·01), in addition to higher morbidity rates (17·8 versus 10·6 per cent; P < 0·001), which included a composite of 21 postoperative adverse events24.…”

Section: Discussionmentioning

confidence: 82%

Sex differences in mortality after abdominal aortic aneurysm repair in the UK

Sidloff

Saratzis

Sweeting

et al. 2017

British Journal of Surgery

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BackgroundThe UK abdominal aortic aneurysm (AAA) screening programmes currently invite only men for screening because the benefit in women is uncertain. Perioperative risk is critical in determining the effectiveness of screening, and contemporary estimates of these risks in women are lacking. The aim of this study was to compare mortality following AAA repair between women and men in the UK.MethodsAnonymized data from the UK National Vascular Registry (NVR) for patients undergoing AAA repair (January 2010 to December 2014) were analysed. Co‐variables were extracted for analysis by sex. The primary outcome measure was in‐hospital mortality. Secondary outcome measures included mortality by 5‐year age groups and duration of hospital stay. Logistic regression was performed to adjust for age, calendar time, AAA diameter and smoking status. NVR‐based outcomes were checked against Hospital Episode Statistics (HES) data.ResultsA total of 23 245 patients were included (13·0 per cent women). Proportionally, more women than men underwent open repair. For elective open AAA repair, the in‐hospital mortality rate was 6·9 per cent in women and 4·0 per cent in men (odds ratio (OR) 1·48, 95 per cent c.i. 1·08 to 2·02; P = 0·014), whereas for elective endovascular AAA repair it was 1·8 per cent in women and 0·7 per cent in men (OR 2·86, 1·72 to 4·74; P < 0·001); the results in HES were similar. For ruptured AAA, there was no sex difference in mortality within the NVR; however, in HES, for ruptured open AAA repair, the in‐hospital mortality rate was higher in women (33·6 versus 27·1 per cent; OR 1·36, 1·16 to 1·59; P < 0·001).ConclusionWomen have a higher in‐hospital mortality rate than men after elective AAA repair even after adjustment. This higher mortality may have an impact on the benefit offered by any screening programme offered to women.

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Section: Discussionmentioning

confidence: 82%

Sex differences in mortality after abdominal aortic aneurysm repair in the UK

Sidloff

Saratzis

Sweeting

et al. 2017

British Journal of Surgery

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“…For instance, the US Medicare database shows that operative mortality after endovascular repair (now the majority procedure) is 3.2% in women compared with 1.8% in men, and similar findings have been reported in other studies. [90][91][92] Therefore, competing risks must be carefully considered before amending guidelines or recommendations for intervention in women.…”

Section: 87mentioning

confidence: 99%

“…At present, large aneurysms (over 5.5 cm in diameter) are referred to elective surgery (open surgery or endovascular aneurysm repair, EVAR), while optimal management of small aneurysms (less than 5.5 cm in diameter), which represents ca. 90 per cent of all screen-detected AAAs, 1 seems to be in favour of surveillance. Three trials showed that survival in patients with small AAAs is not significantly improved by elective surgery, 2-4 while other trials focused on whether early endovascular repair offer a survival benefit to patients with small AAAs.…”

Section: Introductionmentioning

confidence: 98%

“…At present, large aneurysms (over 5.5 cm in diameter) are referred to elective surgery (open surgery or endovascular aneurysm repair, EVAR), while optimal management of small aneurysms (less than 5.5 cm in diameter), which represents ca. 90 per cent of all screen-detected AAAs, 1 seems to be in favour of surveillance. [2][3][4][5] A number of studies have reported on growth rates of small aneurysms and recommended the following frequencies of follow-up examinations ( Table 1).…”

Section: Introductionmentioning

confidence: 99%

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Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness

Thompson

Brown²,

Sweeting³

et al. 2013

Health Technology Assessment

178

177

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This report should be referenced as follows:Thompson SG, Brown LC, Sweeting MJ, Bown MJ, Kim LG, Glover MJ, et al. Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness. Health Technol Assess 2013;17(41). Health Technology Assessment is indexed in MEDLINE, CINAHL, EMBASE, The Cochrane Library and the ISI Science Citation Index and is assessed for inclusion in the Database of Abstracts of Reviews of Effects. Health Technology Assessment is indexed and abstracted inThis journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 08/30/02. The contractual start date was in November 2009. The draft report began editorial review in July 2012 and was accepted for publication in November 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research...

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“…[3,4] Similarly, extremes of underweight have recently been described as a risk factor for surgery. [5][6][7] Several recent studies of critically and chronically ill patients, [8][9][10][11] and of patients undergoing certain procedures [12][13][14][15] suggest that overweight and obese patients may paradoxically have better outcomes than underweight patients, given an increased risk for death and catastrophic complications in the latter patients.…”

Section: Introductionmentioning

confidence: 99%

An analysis of underweight status on 30-day outcomes after breast reconstruction

Eid¹,

Halen²

2016

PAR

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Aim:To examine the impact of underweight body mass index (BMI) values on breast reconstruction outcomes. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent breast reconstruction between 2006 and 2011. Patients were first stratified by breast reconstruction modality into prosthetic or autologous cohorts, and second by BMI values into underweight (BMI < 18.5), normal to overweight (reference, BMI 18.5-29.99), moderate obesity (BMI 30-34.99), severe obesity (BMI 35-39.99), and morbid obesity cohorts. Multivariate logistic regression models were used to determine independent predictors of complications. Results: With regard to prosthetic breast reconstruction patients, obese patients demonstrated increased rates of surgical complications, while underweight patients did not have any differences on multivariable analysis. With respect to autologous reconstruction, risk-adjusted multivariate regression models showed a dose dependent response between obesity and risk for surgical complications and reoperation, but not for underweight patients. Conclusion: On multivariable analysis of over 4,600 patients, there were no significant differences in the rates of adverse events between underweight patients (BMI < 18.5) and their reference-weight counterparts, in spite of a significant increase in surgical and medical complication rates in underweight patients on univariate analysis.

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Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): An analysis using the ACS NSQIP dataset

Cited by 122 publications

References 14 publications

Sex differences in mortality after abdominal aortic aneurysm repair in the UK

Sex differences in mortality after abdominal aortic aneurysm repair in the UK

Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness

An analysis of underweight status on 30-day outcomes after breast reconstruction

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