The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
The George Washington University School Hospital, Washington, District of Columbia, USA.
World J Surg. 2024 Jul;48(7):1783-1790. doi: 10.1002/wjs.12241. Epub 2024 Jun 2.
Stanford Type A Aortic Dissection (TAAD) is an emergent condition with high in-hospital mortality. Gender disparity in TAAD has been a topic of ongoing debate. This study aimed to conduct a population-based examination of gender disparities in short-term TAAD outcomes using the National/Nationwide Inpatient Sample (NIS) database, the largest all-payer database in the US.
Patients undergoing TAAD repair were identified in NIS from the last quarter of 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between male and female patients, adjusted for demographics, comorbidities, hospital characteristics, primary payer status, and transfer status.
There were 1454 female and 2828 male patients identified who underwent TAAD repair. Female patients presented with TAAD were at a more advanced mean age (64.03 ± 13.81 vs. 58.28 ± 13.43 years, p < 0.01) and had greater comorbid burden. Compared to male patients, female patients had higher risks of in-hospital mortality (17.88% vs. 13.68%, adjusted odds ratio (aOR) = 1.266, p = 0.01). In addition, female patients had higher pericardial complications (20.29% vs. 17.22%, aOR = 1.227, p = 0.02), but lower acute kidney injury (AKI; 39.96% vs. 53.47%, aOR = 0.476, p < 0.01) and venous thromboembolism (VTE; 1.38% vs. 2.65%, aOR = 0.517, p = 0.01). Female patients had comparable time from admission to operation and transfer-in status, longer hospital stays, but fewer total hospital expenses.
Female patients were 1.27 times as likely to die in-hospital after TAAD repair but had less AKI and VTE. While there is no evidence suggesting delay in TAAD repair for female patients, the disparities might stem from other differences such as in care provided or intrinsic physiological variations.
斯坦福 A 型主动脉夹层（TAAD）是一种紧急情况，院内死亡率较高。TAAD 中的性别差异一直是一个持续争论的话题。本研究旨在利用美国最大的全支付者数据库国家/全国住院患者样本（NIS）数据库，对 TAAD 短期结局的性别差异进行基于人群的检查。
从 2015 年最后一个季度到 2020 年，在 NIS 中确定接受 TAAD 修复的患者。使用多变量逻辑回归比较男性和女性患者的院内结局，调整了人口统计学、合并症、医院特征、主要支付者状态和转移状态。
共确定了 1454 名女性和 2828 名男性患者接受了 TAAD 修复。女性患者的 TAAD 表现出更严重的平均年龄（64.03±13.81 岁 vs. 58.28±13.43 岁，p<0.01）和更大的合并症负担。与男性患者相比，女性患者的院内死亡率更高（17.88% vs. 13.68%，调整后的优势比（aOR）=1.266，p=0.01）。此外，女性患者的心包并发症发生率更高（20.29% vs. 17.22%，aOR=1.227，p=0.02），但急性肾损伤（AKI；39.96% vs. 53.47%，aOR=0.476，p<0.01）和静脉血栓栓塞（VTE；1.38% vs. 2.65%，aOR=0.517，p=0.01）较低。女性患者的入院至手术时间和转入状态相似，住院时间较长，但总住院费用较少。
女性患者在接受 TAAD 修复后住院期间死亡的可能性增加了 1.27 倍，但 AKI 和 VTE 较少。虽然没有证据表明女性患者的 TAAD 修复存在延迟，但这些差异可能源于护理或内在生理差异等其他差异。
