Massachusetts General Hospital, Boston, MA.
Johns Hopkins University School of Medicine, Baltimore, MD.
Ann Surg. 2019 Oct;270(4):630-638. doi: 10.1097/SLA.0000000000003482.
We sought to assess whether sex-related differences in timely repair of ruptured abdominal aortic aneurysm (rAAA) were associated with excess risk of early mortality in women.
rAAA is a surgical emergency and timeliness of intervention affects outcomes. A door-to-intervention time of <90 minutes is recommended.
All rAAA repairs in the Vascular Quality Initiative from 2003 to 2017 were reviewed. Patients were stratified by sex and time-delay cohorts. Univariate and multivariate analyses were performed.
There were 3719 rAAA repairs, of which 797 (21%) were performed in women. Sex did not affect repair type: open versus endovascular (21% females, each). Despite similar presentation delays [median 6 hours (inter quartile range, IQR: 3-16)], admission-to-intervention time was longer for women than men [median 1.5 hours (IQR 1-4] vs 1.2 hours (IQR 1-3), P=0.047]. Overall, 45% of patients had a >90-minute delay from admission to repair, with more women than men experiencing this delay (49% vs 44%, P=0.01). Neither were more likely to undergo transfer for treatment. After risk adjustment, female sex was associated with a 48% increase in 30-day mortality. Sex differences in mortality were no longer observed in patients with intervention delays of ≤90 minutes. In patients with >90-minute delays, a 77% increase in 30-day mortality of women over men was noted.
Nearly half of rAAA patients have a door-to-intervention time longer than recommended societal guidelines. Sex differences in mortality after rAAA repair seem to be driven by in-hospital treatment delays.
我们旨在评估破裂性腹主动脉瘤（rAAA）修复时机的性别差异是否与女性早期死亡率增加相关。
rAAA 是一种外科急症，干预的及时性会影响结果。建议干预时间应小于 90 分钟。
回顾 2003 年至 2017 年血管质量倡议中的所有 rAAA 修复病例。根据性别和时间延迟队列对患者进行分层。进行单因素和多因素分析。
共有 3719 例 rAAA 修复，其中 797 例（21%）为女性患者。性别并不影响修复类型：开放手术与血管内治疗（女性患者各占 21%）。尽管呈现时间延迟相似[中位数 6 小时（四分位距 IQR：3-16）]，女性患者从入院到干预的时间却长于男性[中位数 1.5 小时（IQR 1-4] vs 1.2 小时（IQR 1-3），P=0.047]。总体而言，45%的患者从入院到修复的时间超过 90 分钟，女性患者中比男性患者更有可能出现这种延迟（49% vs 44%，P=0.01）。女性患者接受转院治疗的可能性也不大。经过风险调整后，女性性别与 30 天死亡率增加 48%相关。在干预时间延迟≤90 分钟的患者中，性别差异导致的死亡率不再明显。在干预时间延迟超过 90 分钟的患者中，女性患者的 30 天死亡率比男性患者增加 77%。
近一半的 rAAA 患者的入院到干预时间超过了社会指南推荐的时间。rAAA 修复术后死亡率的性别差异似乎是由院内治疗延迟所致。
