title: Sex-related trends in mortality after elective abdominal aortic aneurysm surgery between 2002 and 2013 at National Health Service hospitals in England: less benefit for women compared with men.
abstract: To quantify the difference in long-term survival and cardiovascular morbidity between women and men undergoing elective abdominal aortic aneurysm (AAA) repair at National Health Service hospitals in England.
  
  
  
  Patients having elective repair of AAA were reviewed using the Hospital Episode Statistics and Office for National Statistics (ONS) datasets. The primary outcome measure was 30-day mortality and the secondary outcomes were 1-year, 5-year, and aortic-related mortality and post-operative complication rates. We used logistic regression and survival models to assess risk factors on the primary and secondary outcomes. Between 1 April 2002 and 31 March 2013, a total of 31 090 patients (4795 women and 26 295 men) underwent open AAA repair. Between 1 January 2006 and 31 March 2013, a total of 16 777 patients (2036 women and 14 741 men) underwent endovascular aneurysm repair (EVAR). All-cause and aortic-related mortalities at 30 days, 1 year, and 5 years were all higher in women, despite a lower prevalence of pre-operative cardiovascular risk factors. Female sex was a significant independent risk factor for 30-day mortality in both open repair [odds ratio (OR) 1.39; 95% confidence interval (CI) 1.25-1.56; P < 0.001] and EVAR (OR 1.57; 95% CI 1.23-2.00; P < 0.001) groups. Based on an all-cause long-term survival model, conditional on 30-day survival, the estimated hazard for women in the open repair group was significantly (P = 0.006) higher than men, but the sex difference was not significant in the EVAR group (P = 0.356). In the open repair group, women had significantly (P < 0.001) higher cumulative incidence probabilities for both aortic-related mortality and other-cause mortality. In the EVAR group, women had significantly (P < 0.001) higher mean cumulative incidence probabilities for the aortic-related mortality compared with men, but not for the other-cause mortality (P = 0.235).
  
  
  
  Women undergoing elective AAA repair at National Health Service hospitals in England had increased short- and long-term mortality and post-operative morbidity compared with men. These findings can be used to improve pre-operative counselling for women undergoing AAA repair, and highlight the need for female-specific pre-, peri-, and post-operative management strategies.
authors: Department of Vascular Surgery, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK mdesai@nhs.net.
authors: Mital
authors: M
authors: Desai
authors: Department of Cardiovascular Sciences.
authors: Edward
authors: E
authors: Choke
authors: Department of Cardiovascular Sciences.
authors: Robert D
authors: RD
authors: Sayers
authors: Department of Cardiovascular Sciences.
authors: Mintu
authors: M
authors: Nath
authors: Department of Cardiovascular Sciences.|National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK.
authors: Matthew J
authors: MJ
authors: Bown
mesh_terms: D017544:Aortic Aneurysm, Abdominal; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D009313:National Health Programs; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012727:Sex Characteristics; D016896:Treatment Outcome
keywords: Abdominal aortic aneurysm; England; National Health Service; Women