Sex Disparities in Long Term Outcomes After Open Surgery for Chronic Limb Threatening Ischaemia: A Propensity Score Matched Analysis of Health Insurance Claims

Kotov, Artur; Heidemann, Franziska; Kuchenbecker, Jenny; Peters, Frederik; Marschall, Ursula; Acar, Laura; Debus, Eike Sebastian; L’Hoest, Helmut; Behrendt, Christian‐Alexander

doi:10.1016/j.ejvs.2020.11.006

Cited by 11 publications

(4 citation statements)

References 32 publications

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“…Worse clinical outcomes are reported for women, such as a higher rate of adverse events, postoperative outcomes and in-hospital mortality, and discharge to a nonhome facility after surgery [19][20][21][22][23][24][25]. Conversely, equal or even better outcomes are also reported among females when compared to males [26][27][28]. However, in addition to a lower willingness to undergo vascular surgery interventions [29], women are also undertreated or poorly adherent to risk factor control therapy [30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

Lower All-Cause Mortality Risk in Females and Males with Peripheral Artery Disease following Pain-Free Home-Based Exercise: A 7-Year Observational Study

Lamberti

Traina

Savriè

et al. 2023

JPM

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We evaluated the sex-specific difference in response upon participation in an exercise program with respect to the risk of adverse clinical outcomes among patients with peripheral artery disease (PAD) and claudication. The records of 400 PAD patients were assessed between 2012 and 2015. Two hundred of them were addressed to a walking program prescribed at the hospital and executed at home at symptom-free walking speed (Ex), while the remaining 200 acted as a control group (Co). The number and date of deaths, all-cause hospitalizations, and amputations for a 7-year period were collected from the regional registry. At baseline, no differences were observed (MEXn = 138; FEXn = 62; MCOn = 149; FCOn = 51). The 7-year survival rate was significantly higher in FEX (90%) than in MEX (82% hazard ratio, HR: 0.542 95% CI 0.331–0.885), FCO (45%, HR: 0.164 95% CI 0.088–0.305), and MCO (44%; HR: 0.157 95% CI 0.096–0.256). A significantly lower rate of hospitalization (p < 0.001) and amputations (p = 0.016) was observed for the Ex group compared to the Co group, without differences by sex. In conclusion, in PAD patients, active participation in a home-based pain-free exercise program was associated with a lower rate of death and better long-term clinical outcomes, particularly among women.

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Section: Introductionmentioning

confidence: 99%

Lower All-Cause Mortality Risk in Females and Males with Peripheral Artery Disease following Pain-Free Home-Based Exercise: A 7-Year Observational Study

Lamberti

Traina

Savriè

et al. 2023

JPM

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“…In another study, we aim to determine the survival after open surgical and hybrid revascularizations to complement the present results. 29 In addition to several strengths, the present study also had limitations. First, discussion concerning the value of administrative data is currently ongoing.…”

Section: Journal Of Vascular Surgerymentioning

confidence: 90%

“…To adjust for baseline differences between the sexes, we performed propensity score matching as described in detail previously. 29 The scores were calculated and matched using nearest neighbor matching and strictly chosen within the range of 0.1 standard deviations of the distance measure. The performance and quality of the matching were assessed using standardized mean differences (Supplementary Table II, online only).…”

Section: Methodsmentioning

confidence: 99%

A health insurance claims analysis on the effect of female sex on long-term outcomes after peripheral endovascular interventions for symptomatic peripheral arterial occlusive disease

Heidemann

Kuchenbecker

Peters

et al. 2021

Journal of Vascular Surgery

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Objective: Several reports have addressed sex disparities in peripheral arterial occlusive disease (PAOD) treatment with inconclusive or even conflicting results. However, most previous studies have neither been sufficiently stratified nor used matching or weighting methods to address severe confounding. In the present study, we aimed to determine the disparities between sexes after percutaneous endovascular revascularization (ER) for symptomatic PAOD.Methods: Health insurance claims data from the second-largest insurance fund in Germany, BARMER, were used. A large cohort of patients who had undergone index percutaneous ER of symptomatic PAOD from January 1, 2010 to December 31, 2018 were included in the present study. The study cohort was stratified by the presence of intermittent claudication, ischemic rest pain, and wound healing disorders. Propensity score matching was used to adjust for confounding through differences in age, treated vessel region, comorbidities, and pharmacologic treatment. Sex-related differences regarding cardiovascular event-free survival, amputation-free survival, and overall survival within 5 years of surgery were determined using Kaplan-Meier time-to-event curves, log-rank test, and Cox regression analysis.Results: In the present study, 50,051 patients (47.2% women) were identified and used to compose a matched cohort of 35,232 patients. Among all strata, female patients exhibited lower mortality (hazard ratio [HR], 0.69-0.90), fewer amputations or death (HR, 0.70-0.89), and fewer cardiovascular events or death (HR, 0.78-0.91). The association between female sex and improved long-term outcomes was most pronounced for the patients with intermittent claudication. Conclusions:In the present propensity score-matched analysis of health insurance claims, we observed superior cardiovascular event-free survival, amputation-free survival, and overall survival during 5 years of follow-up after percutaneous ER in women with symptomatic PAOD. Future studies should address sex disparities in the open surgical treatment of PAOD to illuminate whether the conflicting data from previous reports might have resulted from insufficient stratification of the studies.

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“…Further, women who undergo revascularisation tend to be older and have more severe PAD compared to men, and these factors can affect outcomes of procedures adversely 177 . Contradictory results exist on women with PAD and mortality rates [178][179][180] . Population studies suggest a trend towards higher mortality rates in women with lower ABI 179 .…”

Section: Sex and Exercisementioning

confidence: 99%

Exercise therapy for chronic symptomatic peripheral artery disease

Mazzolai,

Belch,

Venermo

et al. 2024

Vasa

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Summary: All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.

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Sex Disparities in Long Term Outcomes After Open Surgery for Chronic Limb Threatening Ischaemia: A Propensity Score Matched Analysis of Health Insurance Claims

Cited by 11 publications

References 32 publications

Lower All-Cause Mortality Risk in Females and Males with Peripheral Artery Disease following Pain-Free Home-Based Exercise: A 7-Year Observational Study

Lower All-Cause Mortality Risk in Females and Males with Peripheral Artery Disease following Pain-Free Home-Based Exercise: A 7-Year Observational Study

A health insurance claims analysis on the effect of female sex on long-term outcomes after peripheral endovascular interventions for symptomatic peripheral arterial occlusive disease

Exercise therapy for chronic symptomatic peripheral artery disease

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