Sex Disparity in Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Driven by In-hospital Treatment Delays. Issue 4 (October 2019)

• Record Type: Journal Article
• Authors: Wang, Linda J.; Locham, Satinderjit; Dakour-Aridi, Hanaa; Lillemoe, Keith D.; Clary, Bryan; Malas, Mahmoud B.
• Is Part Of: Annals of surgery. Volume 270:Issue 4(2019)
• Publication Date: 2019-10
• Subjects: in-hospital delay -- mortality -- ruptured abdominal aortic aneurysm -- women; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000003482
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: We sought to assess whether sex-related differences in timely repair of ruptured abdominal aortic aneurysm (rAAA) were associated with excess risk of early mortality in women. Summary Background Data: rAAA is a surgical emergency and timeliness of intervention affects outcomes. A door-to-intervention time of <90 minutes is recommended. Methods: All rAAA repairs in the Vascular Quality Initiative from 2003 to 2017 were reviewed. Patients were stratified by sex and time-delay cohorts. Univariate and multivariate analyses were performed. Results: There were 3719 rAAA repairs, of which 797 (21%) were performed in women. Sex did not affect repair type: open versus endovascular (21% females, each). Despite similar presentation delays [median 6 hours (inter quartile range, IQR: 3–16)], admission-to-intervention time was longer for women than men [median 1.5 hours (IQR 1–4] vs 1.2 hours (IQR 1–3), P =0.047]. Overall, 45% of patients had a >90-minute delay from admission to repair, with more women than men experiencing this delay (49% vs 44%, P =0.01). Neither were more likely to undergo transfer for treatment. After risk adjustment, female sex was associated with a 48% increase in 30-day mortality. Sex differences in mortality were no longer observed in patients with intervention delays of ⩽90 minutes. In patients with >90-minute delays, a 77% increase in 30-day mortality of women over men was noted. Conclusions: Nearly half of rAAA patients have a door-to-intervention time longer than recommended societal guidelines. Sex differences in mortality after rAAA repair seem to be driven by in-hospital treatment delays.