Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
OLVG, Department of Surgery, Amsterdam, the Netherlands.
Eur J Vasc Endovasc Surg. 2019 Dec;58(6):813-820. doi: 10.1016/j.ejvs.2019.05.017. Epub 2019 Nov 6.
The aim was to compare peri-operative (30 day and/or in hospital) mortality between women and men in the Netherlands after elective repair of an asymptomatic abdominal aortic aneurysm (AAA).
This was a retrospective study using data from the Dutch Surgical Aneurysm Audit (DSAA), a mandatory nationwide registry of patients undergoing AAA repair in the Netherlands. Patients who underwent elective open surgical (OSR) or endovascular aneurysm repair (EVAR) of an asymptomatic abdominal aortic aneurysm (AAA) between 2013 and 2018 were included. Absolute risk differences (ARDs) with 95% confidence intervals (CIs) in peri-operative mortality between women and men were estimated. Logistic regression analyses were performed to estimate adjusted odds ratios (ORs) for mortality. Confounders included pre-operative cardiac and pulmonary comorbidity, serum haemoglobin, serum creatinine, type of AAA repair, and AAA diameter.
Some 1662 women and 9637 men were included, of whom 507 (30.5%) women and 2056 (21.3%) men underwent OSR (p < .001). Crude peri-operative mortality was 3.01% in women and 1.60% in men (ARD = 1.41%, 95% CI 0.64-2.37). This significant difference was also observed for OSR (ARD = 2.63%, 95% CI 0.43-5.36), but not for EVAR (ARD = 0.36%, 95% CI -0.16 to 1.17). Female sex remained associated with peri-operative mortality after adjusting for confounders (OR = 1.79, 95% CI 1.20-2.65, p = .004), which was similarly observed for OSR (OR = 1.85, 95% CI 1.16-2.94, p = .01), but not for EVAR (OR = 1.46, 95% CI 0.72-2.95, p = .29).
Peri-operative mortality after elective repair of an asymptomatic AAA in the Netherlands is higher in women than in men. This disparity might be explained by the higher peri-operative mortality in women undergoing OSR, because no such difference was found in patients undergoing EVAR. Yet, it is likely that there are unaccounted factors at play since female sex remained significantly associated with mortality after adjusting for type of repair.
比较荷兰择期修复无症状腹主动脉瘤（AAA）后女性和男性的围手术期（30 天和/或住院期间）死亡率。
这是一项回顾性研究，使用了荷兰外科动脉瘤审计（DSAA）的数据，该数据是荷兰接受 AAA 修复的患者的强制性全国登记处。纳入 2013 年至 2018 年间接受择期开放手术（OSR）或血管内动脉瘤修复（EVAR）治疗无症状腹主动脉瘤（AAA）的患者。估计女性和男性围手术期死亡率的绝对风险差异（ARD）及其 95%置信区间（CI）。进行逻辑回归分析以估计死亡率的调整优势比（OR）。混杂因素包括术前心脏和肺部合并症、血清血红蛋白、血清肌酐、AAA 修复类型和 AAA 直径。
纳入了 1662 名女性和 9637 名男性，其中 507 名（30.5%）女性和 2056 名（21.3%）男性接受了 OSR（p<.001）。女性围手术期死亡率为 3.01%，男性为 1.60%（ARD=1.41%，95%CI 0.64-2.37）。这种显著差异在 OSR 中也观察到（ARD=2.63%，95%CI 0.43-5.36），但在 EVAR 中未观察到（ARD=0.36%，95%CI-0.16-1.17）。在调整混杂因素后，女性性别仍然与围手术期死亡率相关（OR=1.79，95%CI 1.20-2.65，p=0.004），这在 OSR 中也观察到（OR=1.85，95%CI 1.16-2.94，p=0.01），但在 EVAR 中未观察到（OR=1.46，95%CI 0.72-2.95，p=0.29）。
荷兰择期修复无症状 AAA 后女性的围手术期死亡率高于男性。这种差异可能是由于女性接受 OSR 的围手术期死亡率较高所致，因为在接受 EVAR 的患者中没有发现这种差异。然而，由于在调整修复类型后，女性性别与死亡率仍然显著相关，因此可能存在未被发现的因素在起作用。
