Sex differences in outcomes after revascularization for acute lower limb ischemia: Propensity score adjusted analysis

Abstract

BackgroundPrevious reports have suggested higher rates of mortality and amputation for female patients in acute lower limb ischemia (ALI). The aims of the present study were to investigate if there is a difference in mortality, amputation, and fasciotomy between the sexes.MethodsA retrospective cohort study of consecutive patients undergoing index revascularization for ALI between 2001 and 2018 was conducted. A propensity score was created through a logistic regression with female/male sex as an outcome. Cox regression analyses for 90‐day and 1‐year mortality, combining major amputation/mortality, and logistic regression for major bleeding and fasciotomy, were performed. All analyses were performed with and without adjusting for propensity score.ResultsA total of 709 patients were included in the study of which 45.9% were women. Mean age was 72.1 years. Females were older and had higher rates of atrial fibrillation, embolic disease, and lower estimated glomerular filtration rate, while men more often had anemia and chronic peripheral arterial disease. Mortality at 1 year was 21.2% for women and 14.7% for men. The adjusted hazard ratio for 1‐year mortality was 0.99 (95% CI 0.67–1.46). Fasciotomy was performed in 7.1% of female and 12.8% of male patients; the adjusted odds ratio was 0.52 (95% CI 0.29–0.91).ConclusionSex was not found to be an independent risk factor for mortality or combined major amputation/mortality after revascularization for acute lower limb ischemia, whereas women had lower odds of undergoing fasciotomy. Whether women are underdiagnosed or do not develop acute compartment syndrome in the lower leg as often as men should be evaluated prospectively.

Exploring the gender gap in surgical outcomes

“…Karonen and colleagues have shed more light on gender-related differences in outcomes after surgery, and in this case after acute limb ischemia (ALI). 1 By examining a Swedish cohort of patients undergoing open or endovascular revascularization for ALI over 2 decades, gender-specific differences between outcomes were compared. These data show that gender was not a risk factor for major limb amputation or survival during follow-up.…”