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Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis

Objective: Previous studies have showed a potential disadvantage of female patients who underwent abdominal aortic aneurysm (AAA) repair. The current study aims to determine sex-specific perioperative and long-term outcomes using propensity score matched unselected nationwide health insurance claims...

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Autores principales: Behrendt, Christian-Alexander, Kreutzburg, Thea, Kuchenbecker, Jenny, Panuccio, Giuseppe, Dankhoff, Mark, Spanos, Konstantinos, Kouvelos, George, Debus, Sebastian, Peters, Frederik, Kölbel, Tilo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796519/
https://www.ncbi.nlm.nih.gov/pubmed/33466535
http://dx.doi.org/10.3390/jcm10010162
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author Behrendt, Christian-Alexander
Kreutzburg, Thea
Kuchenbecker, Jenny
Panuccio, Giuseppe
Dankhoff, Mark
Spanos, Konstantinos
Kouvelos, George
Debus, Sebastian
Peters, Frederik
Kölbel, Tilo
author_facet Behrendt, Christian-Alexander
Kreutzburg, Thea
Kuchenbecker, Jenny
Panuccio, Giuseppe
Dankhoff, Mark
Spanos, Konstantinos
Kouvelos, George
Debus, Sebastian
Peters, Frederik
Kölbel, Tilo
author_sort Behrendt, Christian-Alexander
collection PubMed
description Objective: Previous studies have showed a potential disadvantage of female patients who underwent abdominal aortic aneurysm (AAA) repair. The current study aims to determine sex-specific perioperative and long-term outcomes using propensity score matched unselected nationwide health insurance claims data. Methods: Insurance claims from a large German fund were used, covering around 8% of the insured German population. Patients who underwent endovascular aortic repair (EVAR) for intact AAA from 1 January 2011 to 30 April 2017 were included in the cohort. A 1:2 female to male propensity score matching was applied to adjust for confounding variables. Perioperative and long-term outcomes after 5 years were determined using matching and regression methods. Results: Among a total of 3736 patients (19.3% females, mean 75 years) undergoing EVAR for intact AAA, we identified 1863 matched patients. Before matching, females were more likely to be previously diagnosed with hypothyroidism, electrolyte disorders, rheumatoid disorders, and depression, while males were more often diabetics. In the matched sample, 23.4% of the females and 25.8% of the males died during a median follow-up of 776 and 792 days, respectively. Perioperatively, females were more likely to exhibit acute limb ischemia (5.3% vs. 3.2%, p = 0.031) and major bleeding (22.0% vs. 15.9%, p = 0.001) before they were discharged to rehabilitation (5.5% vs. 1.5%, p < 0.001) when compared to males. No statistically significant difference in perioperative (odds ratio 1.12, 95% CI 0.54–2.16) or long-term mortality (hazard ratio 0.91, 95% CI 0.76–1.08) was observed between sexes. This was also true regarding aortic reintervention rates after 1 year (2.0% vs. 2.9%) and 5 years (10.9% vs. 8.1%). Conclusion: The current retrospective matched analysis of insurance claims revealed high early access-related morbidity in females when compared to their male counterparts. Short-term or long-term survival and reintervention outcomes were similar between sexes.
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spelling pubmed-77965192021-01-10 Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis Behrendt, Christian-Alexander Kreutzburg, Thea Kuchenbecker, Jenny Panuccio, Giuseppe Dankhoff, Mark Spanos, Konstantinos Kouvelos, George Debus, Sebastian Peters, Frederik Kölbel, Tilo J Clin Med Article Objective: Previous studies have showed a potential disadvantage of female patients who underwent abdominal aortic aneurysm (AAA) repair. The current study aims to determine sex-specific perioperative and long-term outcomes using propensity score matched unselected nationwide health insurance claims data. Methods: Insurance claims from a large German fund were used, covering around 8% of the insured German population. Patients who underwent endovascular aortic repair (EVAR) for intact AAA from 1 January 2011 to 30 April 2017 were included in the cohort. A 1:2 female to male propensity score matching was applied to adjust for confounding variables. Perioperative and long-term outcomes after 5 years were determined using matching and regression methods. Results: Among a total of 3736 patients (19.3% females, mean 75 years) undergoing EVAR for intact AAA, we identified 1863 matched patients. Before matching, females were more likely to be previously diagnosed with hypothyroidism, electrolyte disorders, rheumatoid disorders, and depression, while males were more often diabetics. In the matched sample, 23.4% of the females and 25.8% of the males died during a median follow-up of 776 and 792 days, respectively. Perioperatively, females were more likely to exhibit acute limb ischemia (5.3% vs. 3.2%, p = 0.031) and major bleeding (22.0% vs. 15.9%, p = 0.001) before they were discharged to rehabilitation (5.5% vs. 1.5%, p < 0.001) when compared to males. No statistically significant difference in perioperative (odds ratio 1.12, 95% CI 0.54–2.16) or long-term mortality (hazard ratio 0.91, 95% CI 0.76–1.08) was observed between sexes. This was also true regarding aortic reintervention rates after 1 year (2.0% vs. 2.9%) and 5 years (10.9% vs. 8.1%). Conclusion: The current retrospective matched analysis of insurance claims revealed high early access-related morbidity in females when compared to their male counterparts. Short-term or long-term survival and reintervention outcomes were similar between sexes. MDPI 2021-01-05 /pmc/articles/PMC7796519/ /pubmed/33466535 http://dx.doi.org/10.3390/jcm10010162 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Behrendt, Christian-Alexander
Kreutzburg, Thea
Kuchenbecker, Jenny
Panuccio, Giuseppe
Dankhoff, Mark
Spanos, Konstantinos
Kouvelos, George
Debus, Sebastian
Peters, Frederik
Kölbel, Tilo
Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis
title Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis
title_full Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis
title_fullStr Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis
title_full_unstemmed Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis
title_short Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis
title_sort female sex and outcomes after endovascular aneurysm repair for abdominal aortic aneurysm: a propensity score matched cohort analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796519/
https://www.ncbi.nlm.nih.gov/pubmed/33466535
http://dx.doi.org/10.3390/jcm10010162
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