Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md.
Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md.
J Vasc Surg. 2014 Jan;59(1):45-51. doi: 10.1016/j.jvs.2013.06.058. Epub 2013 Jul 26.
Previous studies have shown that female gender is associated with increased morbidity and mortality after endovascular abdominal aortic aneurysm repair. The goal of this study was to assess the effect of gender on 30-day outcomes after thoracic endovascular aortic aneurysm repair (TEVAR) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
This was a review of the 2005 to 2011 ACS-NSQIP database to identify all patients who underwent TEVAR for nonruptured thoracic aortic aneurysms. Procedure and diagnosis codes were used to capture the study population. Patients were stratified according to gender. Baseline, operative, and outcomes data were compared in bivariate fashion. The primary outcome measure was 30-day mortality, and a risk-adjusted generalized linear model with Poisson distribution was used to identify relative risk.
During the study period, 649 patients, 279 women (43%) and 370 men (57%), underwent TEVAR. Baseline demographics according to gender were similar; however, women were less likely to drink alcohol (1% vs 5%; P = .001) and to have a history of cardiac surgery (14% vs 27%; P < .001). More women required iliac artery exposure (18% vs 7%; P < .001). Operative times (173.6 ± 6.3 vs 159.8 ± 5.2 minutes; P = .03), transfusion rates (30% vs 17%, P = .001), and hospital length of stay (7.7 ± 0.5 vs 7.6 ± 0.5 days; P = .009) were increased in women compared with men. Overall, postoperative complications were similar, but unadjusted mortality was significantly greater in women (6% vs 3%; P = .03). On multivariable analysis, female gender was no longer a significant predictor of mortality (relative risk [RR], 2.30; 95% confidence interval [CI], 0.99-5.34; P = .053). Independent predictors of 30-day mortality included increasing age (RR, 1.05; 95% CI, 1.01-1.09; P = .02), emergency procedure (RR, 3.76; 95% CI, 1.79-7.87; P < .001), and iliac artery exposure (RR, 4.42; 95% CI, 2.07-9.44; P < .001).
Thirty-day unadjusted mortality after TEVAR for nonruptured thoracic aortic aneurysms is increased in women compared with men, but this univariate finding did not persist after risk adjustment. Multivariable analysis showed need for iliac artery exposure, age, and emergency surgery were independently associated with higher mortality rates. These results suggest a need for decreased device delivery size and improvements in endovascular technology.
先前的研究表明，女性性别与血管内腹主动脉瘤修复术后发病率和死亡率增加有关。本研究的目的是使用美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库评估性别对胸主动脉血管内修复术（TEVAR）后 30 天结局的影响。
这是对 2005 年至 2011 年 ACS-NSQIP 数据库的回顾，以确定所有接受非破裂性胸主动脉瘤 TEVAR 的患者。使用程序和诊断代码捕获研究人群。根据性别分层患者。对基线、手术和结局数据进行了双变量比较。主要结局测量是 30 天死亡率，并使用泊松分布的风险调整广义线性模型来确定相对风险。
在研究期间，649 名患者，279 名女性（43%）和 370 名男性（57%）接受了 TEVAR。根据性别划分的基线人口统计学数据相似；然而，女性饮酒的可能性较小（1%对 5%；P =.001），且有心脏手术史的可能性较小（14%对 27%；P <.001）。更多的女性需要暴露髂动脉（18%对 7%；P <.001）。手术时间（173.6 ± 6.3 对 159.8 ± 5.2 分钟；P =.03）、输血率（30%对 17%，P =.001）和住院时间（7.7 ± 0.5 对 7.6 ± 0.5 天；P =.009）在女性中均高于男性。总体而言，术后并发症相似，但女性未调整死亡率显著更高（6%对 3%；P =.03）。多变量分析显示，女性性别不再是死亡率的显著预测因素（相对风险[RR]，2.30；95%置信区间[CI]，0.99-5.34；P =.053）。30 天死亡率的独立预测因素包括年龄增加（RR，1.05；95%CI，1.01-1.09；P =.02）、紧急手术（RR，3.76；95%CI，1.79-7.87；P <.001）和髂动脉暴露（RR，4.42；95%CI，2.07-9.44；P <.001）。
与男性相比，非破裂性胸主动脉瘤 TEVAR 后 30 天未调整死亡率在女性中增加，但这种单变量发现在风险调整后并未持续。多变量分析显示，需要暴露髂动脉、年龄和紧急手术与更高的死亡率独立相关。这些结果表明需要减少器械输送尺寸和改进血管内技术。
