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

Sidloff, David; Saratzis, Athanasios; Sweeting, Michael; Michaels, Jonathan; Powell, J.T.; Thompson, Simon G.; Bown, Matthew J.

doi:10.1002/bjs.10600

Cited by 48 publications

(50 citation statements)

References 37 publications

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“…The contemporary real-world data on outcomes following emergency EVAR and open repair of ruptured and intact AAA in this study support existing evidence 4,18,19,24,25 that EVAR is associated with reduced in-hospital mortality. However, it should be noted that women even had higher rates of postoperative in-hospital mortality following EVAR compared with men.…”

Section: Discussionsupporting

confidence: 82%

“…A recent study 18 using the English National Health Service (NHS) administrative data set and UK National Vascular Registry data demonstrated that in-hospital mortality following elective as well as ruptured AAA is worse in women; this confirmed the findings of previous studies 19 -22 that used national databases and registries, and demonstrated higher mortality rates following repair of AAA among women. A recent economic evaluation supported by clinical outcome data from an administrative data set and national registry reported that screening women for AAA is not cost-effective under various scenarios, including starting screening at an older age 23 .…”

Section: Introductionsupporting

confidence: 75%

“…However, the in-hospital mortality rate was higher among women over the same interval. Overall, 7799 patients underwent open repair; women who had this type of repair were significantly older (mean age 73⋅22 versus 70⋅97 years), had a longer hospital stay (median 13 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) versus 11 (7-19) days) and higher in-hospital mortality rate (18⋅1 versus 15⋅4 per cent). The median duration of critical care stay was also shorter for women ( Table 2).…”

Section: Sex Differences In Outcomes After Emergency Repair Of Intactmentioning

confidence: 99%

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Sex differences in national rates of repair of emergency abdominal aortic aneurysm

Aber

Tong

Chilcott

et al. 2018

British Journal of Surgery

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Background The aim of this study was to assess the sex differences in both the rate and type of repair for emergency abdominal aortic aneurysm (AAA) in England. Methods Hospital Episode Statistics (HES) data sets from April 2002 to February 2015 were obtained. Clinical and administrative codes were used to identify patients who underwent primary emergency definitive repair of ruptured or intact AAA, and patients with a diagnosis of AAA who died in hospital without repair. These three groups included all patients with a primary AAA who presented as an emergency. Sex differences between repair rates and type of surgery (endovascular aneurysm repair (EVAR) versus open repair) over time were examined. Results In total, 15 717 patients (83·3 per cent men) received emergency surgical intervention for ruptured AAA and 10 276 (81·2 per cent men) for intact AAA; 12 767 (62·0 per cent men) died in hospital without attempted repair. The unadjusted odds ratio for no repair in women versus men was 2·88 (95 per cent c.i. 2·75 to 3·02). Women undergoing repair of ruptured AAA were older and had a higher in‐hospital mortality rate (50·0 versus 41·0 per cent for open repair; 30·9 versus 23·5 per cent for EVAR). After adjustment for age, deprivation and co‐morbidities, the odds ratio for no repair in women versus men was 1·34 (1·28 to 1·40). The in‐hospital mortality rate after emergency repair of an intact AAA was also higher among women. Conclusion Women who present as an emergency with an AAA are less likely to undergo repair than men. Although some of this can be explained by differences in age and co‐morbidities, the differences persist after case‐mix adjustment.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionsupporting

confidence: 75%

Section: Sex Differences In Outcomes After Emergency Repair Of Intactmentioning

confidence: 99%

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Sex differences in national rates of repair of emergency abdominal aortic aneurysm

Aber

Tong

Chilcott

et al. 2018

British Journal of Surgery

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“…Abdominal aortic aneurysm (AAA) is four to six times more common in men than in women, but women have an increased risk of rupture at smaller aneurysm diameter. For intact AAA, women are less often eligible for endovascular aortic repair (EVAR) and have worse outcomes, but such sex differences are debated regarding patients with ruptured AAA (rAAA). Although the incidence of rAAA seems to be declining in general, it is unclear whether this is true for both men and women.…”

Section: Introductionmentioning

confidence: 99%

“…Most studies are based on observational data, and potentially affected by selection bias and confounding factors. Although some researchers adjust for confounders, residual confounding may still be substantial. Several countries have introduced population‐based screening of 65‐year‐old men only.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in repair rates and outcomes of patients with ruptured abdominal aortic aneurysm

Zommorodi

Bottai

Hultgren

2019

British Journal of Surgery

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Background: Data are conflicting on sex differences in ruptured abdominal aortic aneurysm (rAAA) repair rates and outcomes have rarely been addressed. The aim of this study was to investigate differences in the management and outcome of rAAA in men and women, and to describe time trends over a 15-year interval.Methods: Data on patients with rAAA were extracted from the Swedish National Patient Registry and the Cause of Death Registry for the interval 2001-2015. The study included patients with rAAA whether or not they were admitted to any hospital in Sweden. A propensity score-matched model was used to determine sex differences in repair type and outcome after rupture. Time trends for rAAA events and mortality were investigated.Results: Some 10 724 patients were identified. A higher percentage of men were admitted to hospital (79⋅8 versus 77⋅5 per cent; P = 0⋅011). Of those admitted, a higher percentage of men than women were treated (56⋅6 versus 40⋅4 per cent, P < 0⋅001). Women were less likely to be treated when diagnosed with rAAA (average treatment effect (ATE) in the model -0⋅080, 95 per cent c.i. -0⋅106 to -0⋅055; P < 0⋅001). Thirty-day mortality was also higher in women (ATE 0⋅094, 0⋅053 to 0⋅135; P < 0⋅001); this effect persisted to 1 year (ATE 0⋅095, 0⋅052 to 0⋅137; P < 0⋅001). Time trends indicated a decrease in rAAA incidence, mostly owing to a decrease among men.Conclusion: In this study, fewer women with rAAA received surgery and 30-day mortality was higher than in men. There was an overall decrease in rAAA incidence, principally in men.

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Primary Care Screening for Abdominal Aortic Aneurysm

Guirguis-Blake

Beil

Senger

et al. 2019

JAMA

125

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IMPORTANCE Ruptured abdominal aortic aneurysms (AAAs) have mortality estimated at 81%. OBJECTIVE To systematically review the evidence on benefits and harms of AAA screening and small aneurysm treatment to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed (publisher supplied only), Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials for relevant English-language studies published through September 2018. Surveillance continued through July 2019. STUDY SELECTION Trials of AAA screening benefits and harms; trials and cohort studies of small (3.0-5.4 cm) AAA treatment benefits and harms. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles and extracted data. The Peto method was used to pool odds ratios (ORs) for AAA-related mortality, rupture, and operations; the DerSimonian and Laird random-effects model was used to pool calculated risk ratios for all-cause mortality. MAIN OUTCOMES AND MEASURES AAA and all-cause mortality; AAA rupture; treatment complications. RESULTS Fifty studies (N = 323 279) met inclusion criteria. Meta-analysis of population-based randomized clinical trials (RCTs) estimated that a screening invitation to men 65 years or older was associated with a reduction in AAA-related mortality over 12 to 15 years (OR, 0.65 [95% CI, 0.57-0.74]; 4 RCTs [n = 124 926]), AAA-related ruptures over 12 to 15 years (OR, 0.62 [95% CI, 0.55-0.70]; 4 RCTs [n = 124 929]), and emergency surgical procedures over 4 to 15 years (OR, 0.57 [95% CI, 0.48-0.68]; 5 RCTS [n = 175 085]). In contrast, no significant association with all-cause mortality benefit was seen at 12-to 15-year follow-up (relative risk, 0.99 [95% CI 0.98-1.00]; 4 RCTs [n = 124 929]). One-time screening was associated with significantly more procedures over 4 to 15 years in the invited group compared with the control group (OR, 1.44 [95% CI, 1.34-1.55]; 5 RCTs [n = 175 085]). Four trials (n = 3314) of small aneurysm surgical treatment demonstrated no significant difference in AAA-related mortality or all-cause mortality compared with surveillance over 1.7 to 12 years. These 4 early surgery trials showed a substantial increase in procedures in the early surgery group. For small aneurysm treatment, registry data (3 studies [n = 14 424]) showed that women had higher surgical complications and postoperative mortality compared with men. CONCLUSIONS AND RELEVANCE One-time AAA screening in men 65 years or older was associated with decreased AAA-related mortality and rupture rates but was not associated with all-cause mortality benefit. Higher rates of elective surgery but no long-term differences in quality of life resulted from screening.

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

Cited by 48 publications

References 37 publications

Sex differences in national rates of repair of emergency abdominal aortic aneurysm

Sex differences in national rates of repair of emergency abdominal aortic aneurysm

Sex differences in repair rates and outcomes of patients with ruptured abdominal aortic aneurysm

Primary Care Screening for Abdominal Aortic Aneurysm

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