Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
Ann Vasc Surg. 2021 Oct;76:330-341. doi: 10.1016/j.avsg.2021.03.049. Epub 2021 Apr 24.
Elective abdominal aortic aneurysm (AAA) repair is performed to prevent rupture. For reasons as yet unknown, the 30-day mortality risk after elective AAA repair is higher in women than in men. We hypothesised that this higher risk might be related to differences in comorbidity.
Systematic review (PROSPERO CRD42019133314) according to PRISMA guidelines. A search in the EMBASE/MEDLINE/CENTRAL databases identified 1870 studies that included patients who underwent elective AAA repair (final search February 17, 2021). Ultimately, 28 studies were included and all reported comorbidities were categorised into 17 comorbidity groups. Additionally, 15 groups of clearly defined comorbidities were used for sensitivity analysis. For both groups, meta-analyses of each comorbidity were performed to estimate the difference in pooled prevalence between women and men with a random effects model.
When analysing data of all reported comorbidities (17 groups), smoking [risk difference (RD) 11%, 95% confidence interval (CI) 4-18], diabetes (RD 3%, 95% CI 2-4), ischaemic heart disease (RD 12%, 95% CI 8-16), arrhythmia (RD 3%, 95% CI 0.4-5), liver disease (RD 0.1%, 95% CI 0.01-0.2), and cancer (RD 3%, 95% CI 2-4)) were less prevalent in women, whereas, hypertension (RD 4%, 95% CI 3-6) and pulmonary disease (RD 4%, 95% CI 3-5) were more prevalent in women. At the time of surgery women were significantly older than men (74.9 years versus 72.4; mean difference 2.4 years (95% CI 2.1-2.7)). In the sensitivity analysis of 15 comorbidity groups, the same comorbidities remained significantly different between women and men, except smoking and arrhythmia. Women had a higher mortality risk than men (RD 1%, 95% CI 1-2).
Although women undergoing elective AAA repair have fewer baseline comorbidities than men, their 30-day mortality risk is higher. In-depth studies on the cause of death in women after elective AAA repair are needed to explain this discrepancy in mortality.
进行择期腹主动脉瘤（AAA）修复是为了预防破裂。由于目前尚不清楚的原因，择期 AAA 修复后 30 天的女性死亡率风险高于男性。我们假设这种更高的风险可能与合并症的差异有关。
根据 PRISMA 指南进行系统评价（PROSPERO CRD42019133314）。在 EMBASE/MEDLINE/CENTRAL 数据库中进行检索，共确定了 1870 项纳入择期 AAA 修复患者的研究（最终检索日期为 2021 年 2 月 17 日）。最终纳入 28 项研究，所有报告的合并症均被归类为 17 个合并症组。此外，还使用了 15 组明确界定的合并症进行敏感性分析。对于这两组，使用随机效应模型对每个合并症的荟萃分析进行分析，以估计女性和男性之间汇总患病率的差异。
当分析所有报告的合并症（17 组）的数据时，发现吸烟[风险差异（RD）11%，95%置信区间（CI）4-18%]、糖尿病（RD 3%，95%CI 2-4%）、缺血性心脏病（RD 12%，95%CI 8-16%）、心律失常（RD 3%，95%CI 0.4-5%）、肝病（RD 0.1%，95%CI 0.01-0.2%）和癌症（RD 3%，95%CI 2-4%）在女性中较为少见，而高血压（RD 4%，95%CI 3-6%）和肺部疾病（RD 4%，95%CI 3-5%）在女性中更为常见。在手术时，女性比男性明显更老（74.9 岁与 72.4 岁；平均差异 2.4 岁（95%CI 2.1-2.7））。在 15 组合并症的敏感性分析中，女性和男性之间的相同合并症仍然存在显著差异，除了吸烟和心律失常。女性的 30 天死亡率风险高于男性（RD 1%，95%CI 1-2%）。
尽管接受择期 AAA 修复的女性的基线合并症少于男性，但她们的 30 天死亡率风险更高。需要对择期 AAA 修复后女性死亡原因进行深入研究，以解释死亡率的这种差异。
