Study Finds Higher Mortality Rates for Women Than Men After EVAR

August 25, 2009—The Society for Vascular Surgery announced that a new study of 30-day outcomes in patients who had endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) revealed that overall morbidity and mortality rates for all patients were 11.9% and 2.1%, respectively. However, when comparing men and women, mortality was almost twice as high in women than in men (3.4% vs 1.8%), and a broad range of postoperative complications were also more likely to occur in women (17.8% vs 10.6%). The study was published by Nick N. Ebedi, MD, et al in the Journal of Vascular Surgery (2009;50:486–491).

The investigators used the American College of Surgeons National Surgical Quality Improvement Program Dataset participant file to identify 3,662 patients who underwent EVAR at 173 hospitals from 2005 to 2007. There were 647 women (17.7%) and 3,015 men (82.3%) included in the study. Data were also analyzed for 55 preoperative defined risk factors, eight procedural and intraoperative variables, and outcomes including 21 postoperative complications.

Investigator Eric D. Endean, MD, stated that women were more likely to present more emergently, have more complex and longer operations, require postoperative blood transfusion, and have longer length of hospital stays. Dr. Endean added that women often have a debilitated physical condition before surgery (recent weight loss, morbid obesity, and functional dependence), chronic obstructive pulmonary disease, or require more complex and longer operations. Women were also found to have an independent risk factor for infectious and wound complications.

"Although the reasons for the risk with EVAR cannot be definitively identified from data obtained in the current study, we hypothesize that at least one factor contributing to this finding may be the more challenging aortic anatomy in women," commented Dr. Endean. "Women tend to have smaller vessels, present for treatment later than men, and may have other anatomic characteristics of the aorta that make EVAR more difficult. In order to improve outcomes of women who undergo repair of their aneurysm using EVAR, we recommend that surgeons appropriately select patients for EVAR and pay close attention to their other medical conditions."