Sex-related Outcome Inequalities in Endovascular Aneurysm Repair

Abstract

Objective/background: Women are known to have a higher rate of postoperative complications and mortality following open abdominal aortic aneurysm (AAA) repair. It is less clear whether this remains true of endovascular aneurysm repair (EVAR). This study examines the association between sex and hospital length of stay (LoS), readmission rates, and mortality following elective EVAR in the population of England between April 2006 and March 2015.

Methods: Retrospective analysis of Hospital Episode Statistics (HES) was performed, including regression analysis of potential factors that may affect the primary outcomes (age, sex, deprivation, comorbidities and Trust volume).

Results: In total, 20,780 EVARs were performed in the time period, 11.2% (n = 2,304) on women. The women were older (78 years [interquartile range {IQR} 74-82 years] vs. 76 years [IQR 70-80 years]; p < .001) and had a longer LoS (5 days [IQR 3-8 days] vs. 4 days [IQR 3-6 days]; p < .001). Women also had a higher readmission rate and mortality rate at both 30 days and 1 year. Following multivariate logistic regression, being female remained significantly related to poor outcome on all outcomes: LoS (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.69-2.05), 30-day readmission (OR 1.23, 95% CI 1.09-1.40), 1-year readmission (OR 1.16, 95% CI 1.06-1.28); 30-day mortality (OR 1.54, 95% CI 1.15-2.07), 1-year mortality (OR 1.24, 95% CI 1.06-1.45). Advancing age and increased comorbidity score were significantly related to longer LoS, higher readmission rates, and higher mortality. Deprivation score was associated with LoS and 1-year readmission rate but not with 30-day readmission and with increased mortality. Higher-volume Trusts (>50 EVARs per year) had higher readmission rates and 1-year mortality.

Conclusion: These population-based data show that, following EVAR, women have a longer LoS and higher readmission and mortality than men. This reflects the same disparity in outcomes that is found in open AAA repair. Further work to clarify the cause of this is needed.

Keywords: EVAR; Endovascular aneurysm repair; Gender; Length of stay; Mortality; Readmission.