Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Br J Surg. 2022 Mar 15;109(4):340-345. doi: 10.1093/bjs/znab465.
Previous studies have focused on patient-related risk factors to explain the higher mortality risk in women undergoing elective abdominal aortic aneurysm (AAA) repair. The aim of this study was to evaluate whether hospital-related factors influence outcomes following AAA repair in women.
Patients undergoing elective AAA repair in 61 hospitals in the Netherlands were identified from the Dutch Surgical Aneurysm Audit registry (2013-2018). A mixed-effects logistic regression analysis was conducted to assess the effect of sex on in-hospital and/or 30-day mortality. This analysis accounted for possible correlation of outcomes among patients who were treated in the same hospital, by adding a hospital-specific random effect to the statistical model. The analysis adjusted for patient-related risk factors and hospital volume of open surgical repair (OSR) and endovascular aneurysm repair (EVAR).
Some 12 034 patients were included in the analysis. The mortality rate was higher in women than among men: 53 of 1780 (3.0 per cent) versus 152 of 10 254 (1.5 per cent) respectively. Female sex was significantly associated with mortality after correction for patient- and hospital-related factors (odds ratio 1.68, 95 per cent c.i. 1.20 to 2.37). OSR volume was associated with lower mortality (OR 0.91 (0.85 to 0.95) per 10-procedure increase) whereas no such relationship was identified with EVAR volume (OR 1.03 (1.01 to 1.05) per 10-procedure increase).
Women are at higher risk of death after abdominal aortic aneurysm repair irrespective of patient- and hospital-related factors.
先前的研究侧重于与患者相关的风险因素，以解释接受择期腹主动脉瘤（AAA）修复的女性死亡率较高的原因。本研究旨在评估医院相关因素是否会影响女性接受 AAA 修复后的结果。
从荷兰外科动脉瘤监测登记处（2013-2018 年）中确定了在荷兰 61 家医院接受择期 AAA 修复的患者。采用混合效应逻辑回归分析评估性别对住院期间和/或 30 天死亡率的影响。该分析通过在统计模型中添加医院特定的随机效应，考虑了在同一医院接受治疗的患者结果之间的可能相关性。该分析调整了患者相关的风险因素以及开放手术修复（OSR）和血管内动脉瘤修复（EVAR）的医院容量。
在分析中纳入了 12034 名患者。女性的死亡率高于男性：分别为 1780 名中的 53 名（3.0%）和 10254 名中的 152 名（1.5%）。在校正患者和医院相关因素后，女性性别与死亡率显著相关（优势比 1.68，95%置信区间 1.20 至 2.37）。OSR 量与死亡率降低相关（每增加 10 例手术，OR 为 0.91（0.85 至 0.95）），而 EVAR 量则无此关系（每增加 10 例手术，OR 为 1.03（1.01 至 1.05））。
女性在接受腹主动脉瘤修复后死亡的风险更高，无论患者和医院相关因素如何。
