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

Abstract

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has been increasingly used for the treatment of descending thoracic aortic aneurysms and dissections. This study sought to evaluate the influence of sex on outcomes after TEVAR. METHODS AND RESULTS: This was an observational study from the Nationwide Readmissions Database analyzing all patients who underwent TEVAR from 2010 to 2018. Sampling weights were used to generate national estimates. International Classification of Diseases–Clinical Modification codes were used to identify patients with thoracic aortic aneurysms or dissections who underwent TEVAR. Patients were dichotomized according to sex, and 1:1 propensity score matching was applied. Mixed model regression for in-hospital mortality and weighted logistic regression with bootstrapping for 30-day readmissions were performed. A supplemental analysis was performed according to pathology (aneurysm or dissection). A weighted total of 27 118 patients were identified. Propensity-matching yielded 5026 risk-adjusted pairs. Men were more likely to undergo TEVAR for type B aortic dissection, whereas women were more likely to undergo TEVAR for aneurysm. In-hospital mortality was roughly 5% and was equivalent in the matched groups. Men were more likely to have paraplegia, acute kidney injury, and arrhythmias, while women were more likely to require transfusions after TEVAR. There were no significant differences in myocardial infarction, heart failure, respiratory failure, spinal cord ischemia, mesenteric ischemia, stroke, or 30-day readmission between the matched groups. On regression analysis, sex was not an independent risk factor for in-hospital mortality. Female sex was, however, significantly associated with a decreased odds of 30-day readmission (odds ratio, 0.90 [95% CI, 0.87–0.92]; P<0.001). CONCLUSIONS: Women are more likely to undergo TEVAR for aneurysms, while men are more likely to undergo TEVAR for type B aortic dissection. In-hospital mortality after TEVAR is comparable among men and women irrespective of indication. Female sex is independently associated with a reduced odds of 30-day readmission after TEVAR.