Sex-Related Differences in Clinical Outcomes After Thoracic Endovascular Aortic Repair

J Am Heart Assoc, 2023 · DOI: 10.1161/JAHA.122.025520 · Published: January 1, 2023

Simple Explanation

This study investigates how sex influences the results of TEVAR, a procedure used to treat aortic aneurysms and dissections in the chest. It looks at in-hospital mortality, complications, and readmission rates. The researchers analyzed data from a large US database, comparing outcomes for men and women who underwent TEVAR between 2010 and 2018. The study found that while men and women had similar mortality rates after TEVAR, women were less likely to be readmitted to the hospital within 30 days.

Study Duration

2010 to 2018

Participants

A weighted total of 27 118 patients

Evidence Level

Observational study

Key Findings

1
Women are more likely to undergo TEVAR for aneurysms, while men are more likely to undergo TEVAR for type B aortic dissection.
2
In-hospital mortality after TEVAR is comparable among men and women, regardless of the reason for the procedure.
3
Female sex is independently associated with a reduced odds of 30-day readmission after TEVAR.

Research Summary

This study from the Nationwide Readmissions Database (NRD) analyzed patients who underwent TEVAR from 2010 to 2018, finding that men were more likely to undergo TEVAR for type B aortic dissection, while women were more likely to undergo TEVAR for aneurysm. In-hospital mortality was similar between men and women, but men experienced higher rates of paraplegia, acute kidney injury, and arrhythmias, while women were more likely to require transfusions. Female sex was independently associated with a decreased odds of 30-day readmission.

Practical Implications

Personalized Treatment

Consider sex-specific factors when planning TEVAR procedures, as men and women may present with different aortic pathologies.

Post-operative Care

Tailor post-operative care based on sex, as men may be more prone to certain complications (e.g., arrhythmia, acute kidney injury) and women to others (e.g., bleeding requiring transfusion).

Reduce Readmissions

Further investigate the reasons for the reduced odds of 30-day readmission in women to implement strategies for reducing readmissions in men.

Study Limitations

1
Reliance on accurate coding in the NRD database.
2
Lack of granularity in patient- and procedure-level data.
3
Inability to track patients over multiple calendar years and across state lines.

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