The influence of gender on mortality in patients after thoracic endovascular aortic repair

Czerny, Martin; Hoebartner, Michael; Sodeck, Gottfried; Funovics, Martin; Juraszek, Andrzej; Dziodzio, Tomasz; Grimm, Michael; Ehrlich, Marek

doi:10.1016/j.ejcts.2011.01.082

Cited by 18 publications

(17 citation statements)

References 20 publications

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“…The median age of our cohort corresponded well to recently published series [10,11]. Interestingly, the number of females in this cohort was lower than in other cohorts of acute type B aortic dissection [12]. The incidence of complicated acute type B aortic dissection was higher than in the recent literature [13].…”

Section: Discussionsupporting

confidence: 86%

The location of the primary entry tear in acute type B aortic dissection affects early outcome

Weiss

Wolner

Folkmann

et al. 2012

European Journal of Cardio-Thoracic Surgery

112

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A primary entry tear at the concavity of the aortic arch as well as a short distance between the primary entry tear and the left subclavian artery are frequently associated with the presence or the development of complicated acute type B aortic dissection. These findings shall help us to further differentiate acute type B aortic dissections in addition to the common categorization in complicated and uncomplicated. These findings may therefore also have an impact on primary treatment.

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Section: Discussionsupporting

confidence: 86%

The location of the primary entry tear in acute type B aortic dissection affects early outcome

Weiss

Wolner

Folkmann

et al. 2012

European Journal of Cardio-Thoracic Surgery

112

View full text Add to dashboard Cite

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“…[1][2][3][4][5][6][7][8][9][10] Women undergoing vascular surgery have been found to have higher mortality rates, more wound complications, greater need for blood transfusion, and increased length of stay. [1][2][3][4][5] In trauma surgery, male sex has been associated with increased mortality, length of stay, and complications. 7 In a broad study of patients undergoing orthopedic surgery, Molina et al 6 found that female sex was an independent risk factor for several complications, including urinary tract infection (UTI), pneumonia, deep surgical site infection (SSI), return to the operating room, and death.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Complications Following Orthopedic Spine Surgery: Is There a Difference Between Men and Women?

et al. 2019

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Background: Patient sex is known to affect outcomes following surgery. Prior studies have not specifically examined sex-stratified outcomes following spine surgery. The objective is to determine the differences between men and women in terms of 30-day complications following spine surgery.Methods: The National Surgical Quality Improvement Program database was queried for patients undergoing spine surgery from 2005 to 2014. Postoperative data were analyzed to determine the differences between men and women with regard to 30-day complications.Results: A total of 41 315 patients (49.0% women, 51% men) were analyzed. Men were more likely to have diabetes (P ¼ .004) and be active smokers (P , .001). Women were more likely to be taking steroids for chronic conditions (P , .001). Postoperatively, women were at increased risk for superficial surgical site infection, urinary tract infection, transfusions, and longer length of stay, whereas men were at increased risk of pneumonia and reintubation. On multivariate analysis, women were associated with urinary tract infections (odds ratio ¼ 2.17) and transfusions (odds ratio ¼ 1.63).Conclusions: Differences in complications are evident between men and women following spine surgery. These differences should be considered during preoperative planning and when consenting patients for surgery.Level of Evidence: 4

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“…8–10 Institutional studies assessing sex differences following TEVAR have suggested no difference in mortality, although these were limited by small sample sizes. 11, 12 One recent, large retrospective study of TEVAR using NSQIP data showed female sex to be associated with increased 30-day mortality. 13 However, the association lost statistical significance after adjusting for intraoperative variables, including operative time and use of iliac artery exposure, suggesting the mortality difference may be, in part, explained by varying aortoiliac and femoral arterial disease burden between sexes.…”

Section: Introductionmentioning

confidence: 99%

Female sex independently predicts mortality after thoracic endovascular aortic repair for intact descending thoracic aortic aneurysms

Deery

Shean

Wang

et al. 2017

Journal of Vascular Surgery

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Objective While sex differences in the pathogenesis, presentation, and outcomes of repair for abdominal aortic aneurysms are well studied, less is known about sex differences following thoracic endovascular aneurysm repair (TEVAR). The goal of this study was to evaluate the association between sex and morbidity and mortality following TEVAR. Methods A retrospective review of all TEVAR in the Society for Vascular Surgery Vascular Quality Initiative (SVS-VQI) registry from 2011–2015 was conducted, excluding those with dissection, trauma, and rupture. Statistical analysis was performed using the Fisher’s exact test and the Mann-Whitney U test for categorical and continuous variables. Multivariable logistic regression and Cox hazards modeling were used to account for differences in demographics, comorbidities, and aneurysm characteristics in 30-day mortality and long-term survival. Results We identified 2,574 patients (40% women) who underwent TEVAR. Women were older, less likely white, and had smaller aortic diameters but larger aortic size indices (aortic diameter/body surface area). Women also had more chronic obstructive pulmonary disease, but less coronary artery disease and fewer coronary interventions. Women were more likely to be symptomatic at presentation and subsequently have a non-elective procedure. Women had higher estimated blood loss (EBL > 500cc: 20% vs. 17%, P = .04), were more likely to be transfused (29% vs. 21%, P < .001), and more frequently underwent iliac access procedures (4.3% vs. 2.1%, P < .01). Operative time and left subclavian intervention were similar. Postoperatively, women had increased median hospital (5 vs. 4 days, P < .001) and intensive care unit lengths of stay (2.5 vs. 2, P < .001) and were less likely discharged home (75% vs. 86%, P < .001). Mortality was higher for women at 30 days (5.4% vs. 3.3%, P < .01) and one year (9.8% vs. 6.3%, P < .01). After adjusting for age, aortic size index, symptoms, and comorbidities, female sex remained independently predictive of 30-day (OR 1.5, 95% CI: 1.1–2.1, P < .01) and long-term mortality (HR 1.3, 95% CI: 1.03–1.6, P = .02). Conclusions Even after adjusting for differences in age and comorbidities, female patients have higher perioperative mortality and lower long-term survival following TEVAR. These findings, along with the rupture risk by sex, should be considered by clinicians when determining the timing of intervention.

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The influence of gender on mortality in patients after thoracic endovascular aortic repair

Cited by 18 publications

References 20 publications

The location of the primary entry tear in acute type B aortic dissection affects early outcome

The location of the primary entry tear in acute type B aortic dissection affects early outcome

Postoperative Complications Following Orthopedic Spine Surgery: Is There a Difference Between Men and Women?

Female sex independently predicts mortality after thoracic endovascular aortic repair for intact descending thoracic aortic aneurysms

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