Gender trends in the repair of ruptured abdominal aortic aneurysms and outcomes
Presented at the Vascular Annual Meeting of the Society for Vascular Surgery, San Diego, Calif, June 5-8, 2008.
Received 28 October 2009; accepted 29 October 2009. published online 18 January 2010.
Background
This study evaluated gender-specific trends in the diagnosis and treatment of ruptured abdominal aortic aneurysms (rAAAs) in the United States Medicare population.
Methods
The Medicare beneficiary database (1995 through 2006) was examined for patients with rAAAs using International Classification of Diseaes, 9th Edition, Clinical Modification (ICD-9-CM) codes. Codes for endovascular aneurysm repair (EVAR) were only available for the year 2000 forward, and thus, analysis of EVAR was limited to 2000 through 2006. Proportions were analyzed by χ2 and continuous variables by t-test. Factors associated with 30-day mortality and discharge home after surgery were analyzed by multivariate logistic regression. The effect of gender and repair type (open or EVAR) on death and the probability of discharge to home after repair were also evaluated.
Results
The rate of hospitalizations per 100,000 Medicare fee-for-service beneficiaries for men decreased by 52% (from 40 to 19) and by 36% for women (from 11 to 7). The observed 30-day mortality rate was overall 7.7% higher for women vs men. The mortality rate for women was higher by 8.9% for open repair and higher by 7.1% for EVAR vs men. Female gender was associated with increased risk of death in multivariate analysis after controlling for age, year, and type of procedure. Women were 9.8% less likely to be discharged to home after rAAA repair, regardless of the type of repair.
Conclusion
In addition to the fact that we have failed to realize a change in the number of women diagnosed with or treated for rAAA, a significant gender difference remains in the outcomes after treatment for rAAA. This differential is present in both the 30-day mortality rate and in the potential to be discharged to home after repair.
dDepartment of Surgery, University of Wisconsin, Madison, Wisc
Correspondence: Leila Mureebe, MD, Duke University Medical Center, Erwin Rd, Hospital North, HAFS Building, Rm 7682B, DUMC Box 3467, Durham, NC 27710
Competition of interest: none.
The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.
ABSTRACT