Ho Vy Thuy, Sorondo Sabina, Forrester Joseph D, George Elizabeth L, Tran Kenneth, Lee Jason T, Garcia-Toca Manuel, Stern Jordan R
Division of Vascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA.
Division of Vascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA.
J Vasc Surg. 2023 Jan;77(1):56-62. doi: 10.1016/j.jvs.2022.07.178. Epub 2022 Aug 6.
Female sex has been associated with decreased mortality after blunt trauma, but whether sex influences the outcomes of thoracic endovascular aortic repair (TEVAR) for traumatic blunt thoracic aortic injury (BTAI) is unknown.
In this retrospective study of a prospectively maintained database, the Vascular Quality Initiative registry was queried from 2013 to 2020 for patients undergoing TEVAR for BTAI. Univariate Student's t-tests and χ tests were performed, followed by multivariate logistic regression for variables associated with inpatient mortality.
Of 806 eligible patients, 211 (26.2%) were female. Female patients were older (47.9 vs 41.8 years, P < .0001) and less likely to smoke (38.3% vs 48.2%, P = .044). Most patients presented with grade III BTAI (54.5% female, 53.6% male), followed by grade IV (19.0% female, 19.5% male). Mean Injury Severity Scores (30.9 + 20.3 female, 30.5 + 18.8 male) and regional Abbreviated Injury Score did not vary by sex. Postoperatively, female patients were less likely to die as inpatients (3.8% vs 7.9%, P = .042) and to be discharged home (41.4% vs 52.2%, P = .008). On multivariate logistic regression, female sex (odds ratio [OR]: 0.05, P = .002) was associated with reduced inpatient mortality. Advanced age (OR: 1.06, P < .001), postoperative transfusion (OR: 1.05, P = .043), increased Injury Severity Score (OR: 1.03, P = .039), postoperative stroke (OR: 9.09, P = .016), postoperative myocardial infarction (OR: 9.9, P = .017), and left subclavian coverage (OR: 2.7, P = .029) were associated with inpatient death.
Female sex is associated with lower odds of inpatient mortality after TEVAR for BTAI, independent of age, injury severity, BTAI grade, and postoperative complications. Further study of the influence of sex on postdischarge outcomes is needed.
女性在钝性创伤后死亡率较低，但性别是否会影响创伤性钝性胸主动脉损伤（BTAI）的胸主动脉腔内修复术（TEVAR）的疗效尚不清楚。
在这项对前瞻性维护数据库的回顾性研究中，查询了2013年至2020年血管质量倡议登记处中接受TEVAR治疗BTAI的患者。进行单因素Student t检验和χ检验，然后对与住院死亡率相关的变量进行多因素逻辑回归分析。
在806例符合条件的患者中，211例（26.2%）为女性。女性患者年龄较大（47.9岁对41.8岁，P <.0001），吸烟可能性较小（38.3%对48.2%，P =.044）。大多数患者表现为III级BTAI（女性54.5%，男性53.6%），其次是IV级（女性19.0%，男性19.5%）。平均损伤严重程度评分（女性30.9 + 20.3，男性30.5 + 18.8）和局部简明损伤评分在性别上没有差异。术后，女性患者住院死亡的可能性较小（3.8%对7.9%，P =.042），出院回家的可能性较小（41.4%对52.2%，P =.008）。在多因素逻辑回归分析中，女性（比值比[OR]：0.05，P =.002）与住院死亡率降低相关。高龄（OR：1.06，P <.001）、术后输血（OR：1.05，P =.043）、损伤严重程度评分增加（OR：1.03，P =.039）、术后中风（OR：9.09，P =.016）、术后心肌梗死（OR：9.9，P =.017）和左锁骨下动脉覆盖（OR：2.7，P =.029）与住院死亡相关。
女性在接受TEVAR治疗BTAI后住院死亡几率较低，与年龄、损伤严重程度、BTAI分级和术后并发症无关。需要进一步研究性别对出院后结局的影响。
