title: Lessons learned from the analysis of gender effect on risk factors and procedural outcomes of lower extremity arterial disease.
abstract: BACKGROUND
  Despite overall improvement, there is still a gender-related disparity in the outcomes of lower extremities peripheral arterial disease (PAD). We analyzed sex-related variability among factors that are known to influence outcomes.
  
  
  METHODS
  Data on PAD inpatient hospitalizations from New York, New Jersey, and Florida state hospital discharge databases (1998-2007) were analyzed using univariate and multivariate logistic regression analyses.
  
  
  RESULTS
  Of the 372,692 surgical hospitalizations identified, 162,730 (43.66%) involved women. Men and women undergoing vascular procedures differed in that more men smoked (18% vs 14%; P<.0001), and more men had coronary artery disease (40% vs 33%; P<.0001). Women were more likely to be obese (11.86% vs 4.89%; P<.0001), black (18.81% vs 12.66%; P<.0001), older, and have critical limb ischemia (CLI) (39.41% vs 37.67%; P<.0001). They had higher mortality (5.26% vs 4.21%; P<.0001) and complication rates, especially bleeding (10.62 % vs 8.19%; P<.0001) and infection (3.23% vs 2.88%; P<.0001). Mortality rates after endovascular procedures were lower and showed marginal difference between genders (2.87% vs 2.11%; P<.0001). The difference was more pronounced after open revascularizations (5.05% for women vs 4.00% for men; P<.0001) and amputations (9.82% for women vs 8.82% for men; P<.0001). Bleeding differences between men and women were greatest when both open and endovascular procedures were done during the same hospitalizations and lowest after major amputations. Similar to bleeding, transgender differences in postoperative infections were more pronounced after combination of open and endovascular procedures. Using a multivariable model, female gender remained a predictor of perioperative mortality, infection, and bleeding after vascular intervention (odds ratios 1.15, 1.21, and 1.32, respectively). Female gender negatively influenced the mortality of patients with cerebrovascular and coronary disease and those of black race even after adjusting for relevant clinical and demographic risk factors. Gender effect on mortality dissipated in octogenarians and patients with claudication.
  
  
  CONCLUSIONS
  Female gender continues to be an important risk factor that negatively influences the outcomes of vascular interventions; however, these effects vary between different high-risk groups and procedures. Gender effect on mortality dissipates in elderly patients. Prompt recognition of the associations between gender and various risk factors of cardiovascular disease and aggressive modification of these risk factors in female patients may improve gender-related disparity in the outcomes of vascular disease.
authors.affiliation: Division of Vascular Surgery, Department of Health Evidence and Policy, Mount Sinai Medical Center/School of Medicine, New York, NY 10021, USA. ageliki.vouyouka@mountsinai.org
authors.forename: Ageliki G
authors.initials: AG
authors.lastname: Vouyouka
authors.forename: Natalia N
authors.initials: NN
authors.lastname: Egorova
authors.forename: Alexander
authors.initials: A
authors.lastname: Salloum
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kleinman
authors.forename: Michael
authors.initials: M
authors.lastname: Marin
authors.forename: Peter L
authors.initials: PL
authors.lastname: Faries
authors.forename: Allan
authors.initials: A
authors.lastname: Moscowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D019992:Databases as Topic; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016387:Women's Health