Gender Disparity in Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Driven by In-Hospital Treatment Delays
Linda J. Wang*1, Satinderjit Locham*2, Hanaa Dakour-Aridi*2, Keith D. Lillemoe1, Bryan Clary3, Mahmoud B. Malas*3
1Massachusetts General Hospital, Boston, MA;2Johns Hopkins University School of Medicine, Baltimore, MD;3University of California San Diego, San Diego, CA
Objective: A door-to-intervention time of <90 minutes is recommended for patients with ruptured abdominal aortic aneurysm (rAAA). We investigated whether sex-related differences in timely repair was associated with excess risk of early mortality in women.
Methods: All rAAA repairs in the Vascular Quality Initiative from 2003-2017 were reviewed. Patients were stratified by gender and time-delay cohorts. Univariate and multivariate analysis were performed.
Results: There were 3,719 rAAA repairs: 2,922 men (79%) and 797 women (21%). Gender did not affect repair type: open vs endovascular (21% females, each). Despite similar presentation delays (median 6hrs [IQR 3,16]), admission-to-intervention time was longer for women than men (median 1.5hrs [IQR 1,4] vs 1.2hrs [IQR 1,3], p=.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=.01). Neither was more likely to undergo transfer for treatment. After risk adjustment, female sex was associated with a 43% 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 71% increase in 30-day mortality of women over men was noted. Table.
Conclusions: Nearly half of rAAA patients have a door-to-intervention time longer than recommended societal guidelines. Sex differences in mortality following rAAA repair appear to be driven by in-hospital treatment delays.
* By Invitation
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