Behrendt Christian-Alexander, Kreutzburg Thea, Kuchenbecker Jenny, Panuccio Giuseppe, Dankhoff Mark, Spanos Konstantinos, Kouvelos George, Debus Sebastian, Peters Frederik, Kölbel Tilo
Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
J Clin Med. 2021 Jan 5;10(1):162. doi: 10.3390/jcm10010162.
Previous studies have showed a potential disadvantage of female patients who underwent abdominal aortic aneurysm (AAA) repair. The current study aims to determine sex-specific perioperative and long-term outcomes using propensity score matched unselected nationwide health insurance claims data.
Insurance claims from a large German fund were used, covering around 8% of the insured German population. Patients who underwent endovascular aortic repair (EVAR) for intact AAA from 1 January 2011 to 30 April 2017 were included in the cohort. A 1:2 female to male propensity score matching was applied to adjust for confounding variables. Perioperative and long-term outcomes after 5 years were determined using matching and regression methods.
Among a total of 3736 patients (19.3% females, mean 75 years) undergoing EVAR for intact AAA, we identified 1863 matched patients. Before matching, females were more likely to be previously diagnosed with hypothyroidism, electrolyte disorders, rheumatoid disorders, and depression, while males were more often diabetics. In the matched sample, 23.4% of the females and 25.8% of the males died during a median follow-up of 776 and 792 days, respectively. Perioperatively, females were more likely to exhibit acute limb ischemia (5.3% vs. 3.2%, = 0.031) and major bleeding (22.0% vs. 15.9%, = 0.001) before they were discharged to rehabilitation (5.5% vs. 1.5%, < 0.001) when compared to males. No statistically significant difference in perioperative (odds ratio 1.12, 95% CI 0.54-2.16) or long-term mortality (hazard ratio 0.91, 95% CI 0.76-1.08) was observed between sexes. This was also true regarding aortic reintervention rates after 1 year (2.0% vs. 2.9%) and 5 years (10.9% vs. 8.1%).
The current retrospective matched analysis of insurance claims revealed high early access-related morbidity in females when compared to their male counterparts. Short-term or long-term survival and reintervention outcomes were similar between sexes.
既往研究显示，接受腹主动脉瘤（AAA）修复术的女性患者存在潜在劣势。本研究旨在利用倾向评分匹配的未筛选全国医疗保险理赔数据，确定性别特异性围手术期和长期结局。
使用来自一家大型德国基金的保险理赔数据，覆盖约8%的德国参保人群。将2011年1月1日至2017年4月30日因完整AAA接受血管内主动脉修复术（EVAR）的患者纳入队列。采用1:2的女性与男性倾向评分匹配来调整混杂变量。使用匹配和回归方法确定5年后的围手术期和长期结局。
在总共3736例因完整AAA接受EVAR的患者中（19.3%为女性，平均年龄75岁），我们确定了1863例匹配患者。匹配前，女性更易先前被诊断为甲状腺功能减退、电解质紊乱、类风湿性疾病和抑郁症，而男性更常为糖尿病患者。在匹配样本中，女性和男性在中位随访776天和792天期间的死亡率分别为23.4%和25.8%。围手术期，与男性相比，女性在出院接受康复治疗前更易出现急性肢体缺血（5.3%对3.2%，P = 0.031）和大出血（22.0%对15.9%，P = 0.001）（5.5%对1.5%，P < 0.001）。两性在围手术期（比值比为1.12，95%置信区间为0.54 - 2.16）或长期死亡率（风险比为0.91，95%置信区间为0.76 - 1.08）方面未观察到统计学显著差异。1年（2.0%对2.9%）和5年（10.9%对8.1%）后的主动脉再次干预率情况也是如此。
当前对保险理赔数据的回顾性匹配分析显示，与男性相比，女性早期与就医相关的发病率较高。两性的短期或长期生存率及再次干预结局相似。
