Multicentre Covariate Adjustment Analysis of Short-Term and 5-Year Outcomes after Endovascular Repair according to Sex

Abstract

Background. Several studies have reported worse outcomes in women compared to men after endovascular aneurysm repair (EVAR). This study aimed to evaluate sex-specific short-term and 5-year outcomes after EVAR. Methods. A total of 409 consecutive patients underwent elective EVAR from 2004 to 2017 at two tertiary hospitals in Western Australia. Baseline, intraoperative, and postoperative variables were examined retrospectively according to sex. The primary outcome was 30-day mortality (death within 30 days after EVAR). Secondary outcomes were 30-day composite endpoint, length of stay after EVAR, 5-year survival, freedom from reintervention, residual aneurysm size after EVAR, and major adverse event rate at 5-year follow-up. Results. A cohort of 409 patients, comprising 57 women (14%) and 352 men (86%), was analysed. Female patients were older (median age, 76.8 versus 73.5 years, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.005) and have a history of coronary artery bypass grafting (11.2% versus 3.5%, p=0.042) and malignancy (24.1% versus 10.5%, p=0.014). No difference in 30-day mortality or composite endpoints was demonstrated for female patients compared with male patients (3.5% versus 0.3%, p=0.052 and 31.6% versus 27.8%, p=0.562, respectively). The Kaplan–Meier curves demonstrated similar 5-year mortality outcomes amongst male and female patients (p=0.928). Long-term survival analysis adjusting for covariates demonstrated no significant difference in long-term mortality, composite endpoints, and reintervention rate between sexes. Conclusion. This study found no significant differences in 30-day and 5-year outcomes between female and male patients treated with EVAR, implying that EVAR remains a safe treatment choice for female patients.