Gender Data Compared for Lower Extremity PAD and Ruptured AAAs

February 1, 2010—The Society for Vascular Surgery announced that a new three-state study shows a slight decrease in inpatient procedures for 2.4 million patients treated for lower extremity peripheral artery disease (PAD) between 1998 and 2007 but reveals gender disparities in emergent hospital admissions and mortality rates for women. The study selected and reviewed state hospital inpatient discharge databases for New York, New Jersey, and Florida. Natalia N. Egorova, PhD, MPH, et al published the study in the Journal of Vascular Surgery (2010;51:372–378).

The investigators reported that compared to men, women had 18% to 27% fewer lower extremity PAD hospitalizations per capita and 33% to 49% fewer vascular procedural hospitalizations than men. Women were persistently more likely than men to be admitted emergently: 56% of women versus 51% of men in 1998 and 57% versus 53% in 2007.

Although there was an overall improvement in mortality rates for both men and women during the study period, the average procedural mortality rate was higher for women than men (4.95% vs 4.37%, respectively). The most pronounced difference in mortality rates was observed after open vascular reconstructions (5.49% in women vs 4% in men). The highest overall mortality rate was seen after amputations (9.89% in women vs 8.9% in men). The lowest mortality rates and the least disparity were observed after endovascular procedures (2.87% in women vs 2.1% in men). Hospital stays were 1.4 days longer for women after procedures to treat PAD in 1998 but were only 0.3 days longer in 2007.

During the past decade, there was a 150% increase in endovascular procedures in women and a 144% increase in procedures in men. Conversely, open procedures decreased by 36% in women and by 30% in men. The amputation rate also declined by 36% in women and by 21% in men. In 1998, women with PAD were more likely than men to have an amputation; however, this disparity was reduced by the end of the study in 2007.

“Endovascular treatment has continued to improve the operative management and outcomes of vascular disease in both genders, reducing the mortality gap,” commented Dr. Egorova. The investigators noted that it is still unclear what causes these differences in outcomes of PAD. However, early recognition of the disease in women, better understanding of gender variability in associated socioeconomic parameters, and clinical risk factors may eliminate this disparity, Dr. Egorova concluded.

A study by Leila Mureebe, MD, et al published January 18 online ahead of print in the Journal of Vascular Surgery, evaluated gender-specific trends in the diagnosis and treatment of ruptured abdominal aortic aneurysms (rAAAs) in the United States Medicare population.

The investigators examined the Medicare beneficiary database (1995–2006) for patients with rAAAs using International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) codes. Codes for endovascular aneurysm repair (EVAR) were only available for the year 2000 forward, and thus, analysis of EVAR was limited to 2000 through 2006. Proportions were analyzed by X² and continuous variables by ^t-test. Factors associated with 30-day mortality and discharge home after surgery were analyzed by multivariate logistic regression. The effect of gender and repair type (open or EVAR) on death and the probability of discharge to home after repair were also evaluated.

The investigators reported that the rate of hospitalizations per 100,000 Medicare fee-for-service beneficiaries for men decreased by 52% (from 40 to 19) and by 36% for women (from 11 to seven). The observed 30-day overall mortality rate was 7.7% higher for women compared to men. The mortality rate for women was higher by 8.9% for open repair and higher by 7.1% for EVAR compared to men. Female gender was associated with increased risk of death in multivariate analysis after controlling for age, year, and type of procedure. Women were 9.8% less likely to be discharged to home after rAAA repair, regardless of the type of repair.

The investigators concluded that in addition to there being no change in the number of women diagnosed with or treated for rAAA, a significant gender difference remains in the outcomes after treatment for rAAA. This differential is present in both the 30-day mortality rate and the potential to be discharged to home after repair.