Gender differences in incidence and in-hospital outcomes of surgical aortic valve replacement in Spain, 2001–15

Abstract

Background we aim to examine trends in the incidence of surgical aortic valve replacement (SAVR) among women and men in Spain from 2001 to 2015; compare in-hospital outcomes for mechanical and bioprosthetic SAVR by gender and; to identify factors associated with in-hospital mortality (IHM) after SAVR. Methods We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001–15. We included patients that had SAVR as procedure in their discharge report. Propensity score matching (PSM) was performed to assess the impact of gender on the outcomes of mechanical and bioprosthetic SAVR. Results We identified 86 578 patients who underwent SAVR (40% women). Incidence of SVAR was higher in men (incidence rate ratio 1.57; 95%CI 1.55–1.59). In 2001, 73.36% of the men and 71.57% of women received a mechanical prosthesis; these proportions decreased to 43.04% in men and 35.89% in women in 2015, whereas bioprosthetic SAVR increased to 56.96% and 64.11%. After PSM we found that IHM was higher in women than in matched men for mechanical (8.94% vs. 6.79%; P < 0.001) and bioprosthetic (6.51 vs. 5.42%; P = 0.001) SAVR. The mean length of hospital stay was longer (19.54 vs. 18.74 days; P < 0.001) among females than males undergoing mechanical SAVR. Higher IHM after SAVR was associated with older age, comorbidities (except diabetes and atrial fibrillation), concomitant coronary artery bypass graft and emergency room admission. Conclusions This nation-wide analysis over 15 years of gender-specific outcomes after SAVR showed that, after PSM women have significantly higher IHM after mechanical and bioprosthetic SAVR than men.

Gender differences in aortic valve replacement: is surgical aortic valve replacement riskier and transcatheter aortic valve replacement safer in women than in men?

“…Their study suggested that women had more vascular complications and blood transfusions than men and were more likely to be discharged to a skilled nursing facility, nursing home, or intermediate care centre (15). A higher IHM in women was also registered in the 2019 study from Lopéz-de-Andrés et al where they stated that females had significantly higher IHM irrespective of all the comorbid conditions analysed (16). These results differ from some older studies that, after adjustment of the results, did not show a significant difference in IHM and suggest that there is no greater than a 2.5-fold increase in risk for females compared with males undergoing AVR.…”

“…Studies have shown that the risk profile and baseline conditions for women and men undergoing the SAVR procedure is different (15,16). Compared with men, women are typically older and have more non-atherosclerotic comorbid conditions, such as hypertension, diabetes mellitus (DM), obstructive pulmonary disease, atrial fibrillation/flutter (AF) and anaemia, but a lower prevalence of coronary and peripheral arterial disease (PAD), renal disease, cerebrovascular disease and prior sternotomies (15,16). This supports the findings of other studies that SAVR is generally used in lower risk patient groups and may explain why this procedure is more commonly used in men (28).…”

Sex difference and outcome trends following transcatheter aortic valve replacement

“…Thus, after AVR, women suffer significantly more than men from in-hospital and 30-day morbidity and mortality ( 3 – 10 , 13 , 21 – 23 ). However, although the short-term outcomes are worse, female patients have shown better long-term outcomes with higher survival rates ( 6 , 9 , 11 , 12 , 14 , 16 , 26 – 32 ) known as the sex paradox.…”

Regional and sex differences in retinal detachment surgery: Japan-retinal detachment registry report

“…Non-medical factors influencing medical care include regional differences, education, socio-economic status, and ethnicity 10 – 18 . Regarding sex differences, there are reports of poorer postoperative outcomes in women with cardiovascular diseases and cerebral infarctions 11 , 13 . In ophthalmology, the poorer baseline findings at the initial treatment of female patients have been reported for diabetic macular edema and age-related macular degeneration 19 , 20 .…”