title: Influence of Gender on Abdominal Aortic Aneurysm Repair in the Community.
abstract: BACKGROUND
  Women have been shown to experience inferior outcomes following intact and ruptured abdominal aortic aneurysm (AAA) treatment in endovascular aneurysm repair (EVAR) and open surgical repair (OSR) groups. The goal of our study was to compare gender-specific presentation, management, and early outcomes after AAA repair using a statewide registry.
  
  
  METHODS
  We utilized the Washington State's Vascular Interventional Surgical Care and Outcomes Assessment Program registry data collected in 19 hospitals from July 2010 to September 2013. Demographics, presentation, procedural data, and outcomes in elective and emergent AAA repair groups were analyzed.
  
  
  RESULTS
  We identified 1,231 patients (19.6% women) who underwent intact (86.4%) or ruptured AAA (13.6%) repairs. Nine thousand seventy-two (79.0%) patients had EVAR and 259 (21.0%) had OSR. Men and women were of equivalent age and had similar comorbidities, except that women had less coronary artery disease (P < 0.01) and were more likely to suffer from chronic obstructive pulmonary disease (P = 0.05). Women had smaller aneurysm diameters (5.8 ± 1.1 vs. 6.2 ± 1.8 cm, P < 0.01) at the time of presentation and men had slightly higher incidence of rupture at larger aneurysm size. Men were more likely to undergo EVAR, with significant differences in elective (82.1% vs. 74.1%, P = 0.01), but not ruptured repair. Women had significantly higher mortality rates following elective EVAR (3.1% vs. 0.6%, P = 0.01), but not after ruptured or elective open repair. Following elective EVAR, women were less likely to be discharged to home after longer hospital stays (3 vs. 2 days, P < 0.01).
  
  
  CONCLUSIONS
  Despite presentation at a similar age, with a smaller aneurysm diameter, and similar medical comorbidities, women experience substantially worse hospital outcomes primarily driven by elective endovascular procedures. Utilization of endovascular techniques in women still remains lower compared with men. Improvement of elective outcomes in women will likely depend on technical advancements in repair techniques and management strategies that may differ between genders.
authors: Department of Surgery, University of Washington School of Medicine, Seattle, WA. Electronic address: daiva@uw.edu.
authors: Daiva
authors: D
authors: Nevidomskyte
authors: Department of Surgery, University of Washington School of Medicine, Seattle, WA.
authors: Sherene
authors: S
authors: Shalhub
authors: Department of Surgery, University of Washington School of Medicine, Seattle, WA.
authors: Niten
authors: N
authors: Singh
authors: Providence Regional Medical Center Everett, Everett, WA.
authors: Ellen
authors: E
authors: Farokhi
authors: Department of Surgery, University of Washington School of Medicine, Seattle, WA.
authors: Mark H
authors: MH
authors: Meissner
mesh_terms: D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D017558:Elective Surgical Procedures; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D011183:Postoperative Complications / Q000209:etiology; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014861:Washington