Female Sex Studied as an Independent Predictor of Mortality After TEVAR for Intact Descending TAA
June 28, 2017—Findings from a retrospective review focusing on sex difference in thoracic endovascular aneurysm repairs (TEVARs) in the Society for Vascular Surgery Vascular Quality Initiative (VQI) registry from 2011 to 2015 were published by Susan E. Deery, MD, et al in Journal of Vascular Surgery (JVS; 2017;66:2–8).
The investigators concluded in JVS that female patients have higher perioperative mortality and lower long-term survival rates after TEVAR, even after adjusting for differences in age and comorbidities. They advised that these findings, along with the rupture risk by sex, should be considered by clinicians in determining the timing of intervention.
According to the investigators, less is known about sex differences after TEVAR compared with the well-studied sex differences in the pathogenesis, presentation, and outcomes of repair for abdominal aortic aneurysms. Therefore, the goal of this study was to evaluate the association between sex and morbidity with mortality after TEVAR.
As summarized in JVS, the investigators' review excluded TEVARs involving dissection, trauma, and rupture. Statistical analysis was performed using the Fisher 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.
The investigators identified 2,574 patients (40% women) who underwent TEVAR. Compared to men, women were older, were less likely to be Caucasian, and had smaller aortic diameters but larger aortic size indices (aortic diameter/body surface area). Additionally, women had more chronic obstructive pulmonary disease but less coronary artery disease and fewer coronary interventions. Women were also more likely to be symptomatic at presentation and subsequently more likely to have a nonelective procedure.
The reviewed showed that women had higher estimated blood loss > 500 mL (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 stays (5 vs 4 days; P < .001) and intensive care unit stays (2.5 vs 2 days; P < .001) and were less likely to be discharged home (75% vs 86%; P < .001). Mortality was higher for women at 30 days (5.4% vs 3.3%; P < .01) and at 1 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 mortality (odds ratio, 1.5; 95% confidence interval, 1.1–2.1; P < .01) and long-term mortality (hazard ratio, 1.3; 95% confidence interval, 1.03–1.6; P = .02), reported the investigators in JVS.