Mortality following elective abdominal aortic aneurysm repair in women

V N Tedjawirja; A J Alberga; M H P Hof; A C Vahl; M J W Koelemay; R Balm; Dutch Society of Vascular Surgery

doi:10.1093/bjs/znab465

Mortality following elective abdominal aortic aneurysm repair in women

Br J Surg. 2022 Mar 15;109(4):340-345. doi: 10.1093/bjs/znab465.

Authors

V N Tedjawirja¹, A J Alberga^{2

3}, M H P Hof⁴, A C Vahl⁵, M J W Koelemay¹, R Balm¹; Dutch Society of Vascular Surgery

Collaborators

Dutch Society of Vascular Surgery:
P J van den Akker, G J Akkersdijk, G P Akkersdijk, W L Akkersdijk, M G van Andringa de Kempenaer, C H P Arts, J A M Avontuur, O J Bakker, R Balm, W B Barendregt, J A Bekken, M H Bender, B L Bendermacher, M van den Berg, P Berger, R J Beuk, J D Blankensteijn, R J Bleker, J J Blok, A S Bode, M E Bodegom, K E van der Bogt, A P M Boll, M H Booster, B L Borger van der Burg, G J de Borst, W T G J Bos-van Rossum, J Bosma, J M J Botman, L H Bouwman, V Brehm, M T de Bruijn, J L de Bruin, P Brummel, J P van Brussel, S E Buijk, M A Buijs, M G Buimer, D H Burger, H C Buscher, E Cancrinus, P H Castenmiller, G Cazander, A M Coester, P H Cuypers, J H Daemen, I Dawson, J E Dierikx, M L Dijkstra, J Diks, M K Dinkelman, M Dirven, D E Dolmans, R C van Doorn, L M van Dortmont, J W Drouven, M M van der Eb, D Eefting, G J van Eijck, J W Elshof, B H Elsman, A van der Elst, M I van Engeland, R G van Eps, M J Faber, W M de Fijter, B Fioole, T M Fokkema, F A Frans, W M Fritschy, P H Fung Kon Jin, R H Geelkerken, W B van Gent, G J Glade, B Govaert, R P Groenendijk, H G de Groot, R F van den Haak, E F de Haan, G F Hajer, J F Hamming, E S van Hattum, C E Hazenberg, P P Hedeman Joosten, J N Helleman, L G van der Hem, J M Hendriks, J A van Herwaarden, J M Heyligers, J W Hinnen, R J Hissink, G H Ho, P T den Hoed, M T Hoedt, F van Hoek, R Hoencamp, W H Hoffmann, W Hogendoorn, A W Hoksbergen, E J Hollander, M Hommes, C J Hopmans, L C Huisman, R G Hulsebos, K M Huntjens, M M Idu, M J Jacobs, M F van der Jagt, J R Jansbeken, R J Janssen, H H Jiang, S C de Jong, T A Jongbloed-Winkel, V Jongkind, M R Kapma, B P Keller, A Khodadade Jahrome, J K Kievit, P L Klemm, P Klinkert, N A Koedam, M J Koelemaij, J L Kolkert, G G Koning, O H Koning, R Konings, A G Krasznai, R M Krol, R H Kropman, R R Kruse, L van der Laan, M J van der Laan, J H van Laanen, G W van Lammeren, D A Lamprou, J H Lardenoye, G J Lauret, B J Leenders, D A Legemate, V J Leijdekkers, M S Lemson, M M Lensvelt, M A Lijkwan, R C Lind, F T van der Linden, P F Liqui Lung, M J Loos, M C Loubert, K M van de Luijtgaarden, D E Mahmoud, C G Manshanden, E C Mattens, R Meerwaldt, B M Mees, G C von Meijenfeldt, T P Menting, R Metz, R C Minnee, J C de Mol van Otterloo, M J Molegraaf, Y C Montauban van Swijndregt, M J Morak, R H van de Mortel, W Mulder, S K Nagesser, C C Naves, J H Nederhoed, A M Nevenzel-Putters, A J de Nie, D H Nieuwenhuis, J Nieuwenhuizen, R C van Nieuwenhuizen, D Nio, V J Noyez, A P Oomen, B I Oranen, J Oskam, H W Palamba, A G Peppelenbosch, A S van Petersen, B J Petri, M E Pierie, A J Ploeg, R A Pol, E D Ponfoort, I C Post, P P Poyck, A Prent, S Ten Raa, J T Raymakers, M Reichart, B L Reichmann, M M Reijnen, J A de Ridder, A Rijbroek, M J van Rijn, R A de Roo, E V Rouwet, B R Saleem, P B Salemans, M R van Sambeek, M G Samyn, H P van 't Sant, J van Schaik, P M van Schaik, D M Scharn, M R Scheltinga, A Schepers, P M Schlejen, F J Schlosser, F P Schol, V P Scholtes, O Schouten, M A Schreve, G W Schurink, C J Sikkink, A Te Slaa, H J Smeets, L Smeets, R R Smeets, A A de Smet, P C Smit, T M Smits, M G Snoeijs, A O Sondakh, M J Speijers, T J van der Steenhoven, S M van Sterkenburg, D A Stigter, R A Stokmans, R P Strating, G N Stultiëns, J E Sybrandy, J A Teijink, B J Telgenkamp, M Teraa, M J Testroote, T Tha-In, R M The, W J Thijsse, I Thomassen, I F Tielliu, R B van Tongeren, R J Toorop, E Tournoij, M Truijers, K Türkcan, R P Tutein Nolthenius, Ç Ünlü, R H Vaes, A A Vafi, A C Vahl, E J Veen, H T Veger, M G Veldman, S Velthuis, H J Verhagen, B A Verhoeven, C F Vermeulen, E G Vermeulen, B P Vierhout, R J van der Vijver-Coppen, M J Visser, J A van der Vliet, C J Vlijmen-van Keulen, R Voorhoeve, J R van der Vorst, A W Vos, B de Vos, C G Vos, G A Vos, M T Voute, B H Vriens, P W Vriens, A C de Vries, D K de Vries, J P de Vries, M de Vries, C van der Waal, E J Waasdorp, B M Wallis de Vries, L A van Walraven, J L van Wanroij, M C Warlé, W van de Water, V van Weel, A M van Well, G M Welten, R J Welten, J J Wever, A M Wiersema, O R Wikkeling, W I Willaert, J Wille, M C Willems, E M Willigendael, E D Wilschut, W Wisselink, M E Witte, C H Wittens, C Y Wong, R Wouda, O Yazar, K K Yeung, C J Zeebregts, M L van Zeeland

Affiliations

¹ Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
² Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
³ Dutch Institute of Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.
⁴ Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁵ Department of Surgery, OLVG, Amsterdam, the Netherlands.

Abstract

Background: Previous studies have focused on patient-related risk factors to explain the higher mortality risk in women undergoing elective abdominal aortic aneurysm (AAA) repair. The aim of this study was to evaluate whether hospital-related factors influence outcomes following AAA repair in women.

Methods: Patients undergoing elective AAA repair in 61 hospitals in the Netherlands were identified from the Dutch Surgical Aneurysm Audit registry (2013-2018). A mixed-effects logistic regression analysis was conducted to assess the effect of sex on in-hospital and/or 30-day mortality. This analysis accounted for possible correlation of outcomes among patients who were treated in the same hospital, by adding a hospital-specific random effect to the statistical model. The analysis adjusted for patient-related risk factors and hospital volume of open surgical repair (OSR) and endovascular aneurysm repair (EVAR).

Results: Some 12 034 patients were included in the analysis. The mortality rate was higher in women than among men: 53 of 1780 (3.0 per cent) versus 152 of 10 254 (1.5 per cent) respectively. Female sex was significantly associated with mortality after correction for patient- and hospital-related factors (odds ratio 1.68, 95 per cent c.i. 1.20 to 2.37). OSR volume was associated with lower mortality (OR 0.91 (0.85 to 0.95) per 10-procedure increase) whereas no such relationship was identified with EVAR volume (OR 1.03 (1.01 to 1.05) per 10-procedure increase).

Conclusion: Women are at higher risk of death after abdominal aortic aneurysm repair irrespective of patient- and hospital-related factors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aortic Aneurysm, Abdominal*
Blood Vessel Prosthesis Implantation* / methods
Elective Surgical Procedures / methods
Endovascular Procedures* / methods
Female
Hospital Mortality
Humans
Male
Retrospective Studies
Risk Factors
Treatment Outcome