Editor's Choice - Sex Specific Differences in the Management of Descending Thoracic Aortic Aneurysms: Systematic Review with Meta-Analysis

Pinar Ulug; Janet T Powell; Rene Warschkow; Regula S von Allmen

doi:10.1016/j.ejvs.2019.04.022

Editor's Choice - Sex Specific Differences in the Management of Descending Thoracic Aortic Aneurysms: Systematic Review with Meta-Analysis

Eur J Vasc Endovasc Surg. 2019 Oct;58(4):503-511. doi: 10.1016/j.ejvs.2019.04.022. Epub 2019 Jul 29.

Authors

Pinar Ulug¹, Janet T Powell², Rene Warschkow³, Regula S von Allmen⁴

Affiliations

¹ Vascular Surgery Research Group, Imperial College London, London, UK.
² Vascular Surgery Research Group, Imperial College London, London, UK. Electronic address: j.powell@imperial.ac.uk.
³ Clinic for Visceral Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
⁴ Clinic for Vascular Surgery, Kantonsspital St Gallen, St. Gallen, Switzerland; Swiss Cardiovascular Centre, Department of Cardiovascular Surgery, University Hospital Bern and University of Bern, Bern, Switzerland.

PMID: 31371067
DOI: 10.1016/j.ejvs.2019.04.022

Abstract

Objectives: To assess sex specific differences in 30 day mortality, length of hospital stay, and adverse neurological events following repair of intact degenerative descending thoracic aortic aneurysms (TAAs), by either thoracic endovascular (TEVAR) or open repair.

Methods: MEDLINE, Embase, and CENTRAL databases were searched from 2005 to 2019, using ProQuest Dialog. The reviews were registered in PROSPERO (CRD42017020026) and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was 30 day mortality; secondary outcomes were length of hospital stay and adverse neurological events. Forest plots with random effects meta-analysis to provide odds ratios (OR) were used for primary assessment.

Results: For TEVAR, seven studies were identified, including 2758 women and 4674 men; of these studies six were eligible for the primary outcome of 30 day mortality, including 1756 women and 2619 men. There were 94/1756 deaths in women and 82/2619 deaths in men, yielding a pooled 30 day mortality of 5% (95% confidence interval [CI] 3-7) in women and 3% (95% CI 2-4) in men (OR 1.75, 95% CI 1.29-2.38). Length of hospital stay was longer in women, with a standardised mean difference of 0.3 days (95% CI 0.14-0.47; six studies): meta-regression analysis did not identify the slightly older age of women as significant factor in these differences. Stroke rate was not different between the sexes. For open repair only a single study, with national coverage, was identified: this study reported similar 30 day mortality in men and women.

Conclusions: In the management of intact degenerative descending TAAs, 30 day mortality after TEVAR appears to be much higher in women than men with no reasons for this difference identified. However, for open repair there is a lack of contemporary evidence owing to insufficient recent data.

Keywords: Descending thoracic aortic aneurysm; Length of stay; Operative mortality; Sex; TEVAR.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Aged
Aged, 80 and over
Aortic Aneurysm, Thoracic / diagnostic imaging
Aortic Aneurysm, Thoracic / mortality
Aortic Aneurysm, Thoracic / surgery*
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / mortality
Endovascular Procedures* / adverse effects
Endovascular Procedures* / mortality
Female
Health Status Disparities*
Healthcare Disparities*
Humans
Length of Stay
Male
Middle Aged
Postoperative Complications / mortality
Postoperative Complications / therapy
Risk Assessment
Risk Factors
Sex Factors
Time Factors
Treatment Outcome