Sex differences in mortality after abdominal aortic aneurysm repair in the UK
British Journal of Surgery
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Sidloff, D., Saratzis, A., Sweeting, M., Michaels, J., Powell, J., Thompson, S., & Bown, M. (2017). Sex differences in mortality after abdominal aortic aneurysm repair in the UK. British Journal of Surgery, 104 1656-1664. https://doi.org/10.1002/bjs.10600
Background The UK abdominal aortic aneurysm (AAA) screening programmes currently invite only men for screening because the benefit in women is uncertain. Perioperative risk is critical in determining the effectiveness of screening, and contemporary estimates of these risks in women are lacking. The aim of this study was to compare mortality following AAA repair between women and men in the UK. Methods Anonymized data from the UK National Vascular Registry (NVR) for patients undergoing AAA repair (January 2010 to December 2014) were analysed. Co-variables were extracted for analysis by sex. The primary outcome measure was in-hospital mortality. Secondary outcome measures included mortality by 5-year age groups and duration of hospital stay. Logistic regression was performed to adjust for age, calendar time, AAA diameter and smoking status. NVR-based outcomes were checked against Hospital Episode Statistics (HES) data. Results A total of 23 245 patients were included (13·0 per cent women). Proportionally, more women than men underwent open repair. For elective open AAA repair, the in-hospital mortality rate was 6·9 per cent in women and 4·0 per cent in men (odds ratio (OR) 1·48, 95 per cent c.i. 1·08 to 2·02; P = 0·014), whereas for elective endovascular AAA repair it was 1·8 per cent in women and 0·7 per cent in men (OR 2·86, 1·72 to 4·74; P < 0·001); the results in HES were similar. For ruptured AAA, there was no sex difference in mortality within the NVR; however, in HES, for ruptured open AAA repair, the in-hospital mortality rate was higher in women (33·6 versus 27·1 per cent; OR 1·36, 1·16 to 1·59; P < 0·001). Conclusion Women have a higher in-hospital mortality rate than men after elective AAA repair even after adjustment. This higher mortality may have an impact on the benefit offered by any screening programme offered to women.
D.A.S. and A.S. are funded by the UK NIHR. This paper was written in collaboration with members of the SWAN project, a modelling study to examine the potential clinical benefit and cost-effectiveness of AAA screening in women (www.nets.nihr.ac.uk/projects/hta/1417901). The SWAN project was funded by the UK NIHR HTA programme (project number 14/179/01). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. The aspect of this paper relating to the analysis of HES presents independent research funded by the NIHR under the Programme Grants for Applied Research programme (RP-PG-1210-12009). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Department of Health (via National Institute for Health Research (NIHR)) (14/179/01)
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
External DOI: https://doi.org/10.1002/bjs.10600
This record's URL: https://www.repository.cam.ac.uk/handle/1810/266328
Attribution-NonCommercial 4.0 International, Attribution-NonCommercial 4.0 International, Attribution-NonCommercial 4.0 International
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