Objective

Previously, reports have shown that women experience a higher mortality rate than men after elective open (OAR) and endovascular (EVAR) repair of abdominal aortic aneurysm (AAA). With recent improvements in overall AAA repair outcomes, this study aimed to identify whether sex specific disparity has been ameliorated by modern practice, and to define sex specific differences in peri- and post-operative complications and pre-operative status; factors which may contribute to poor outcome.

Methods

This was a systematic review, meta-analysis, and meta-regression of sex specific differences in 30 day mortality and complications conducted according to PRISMA guidance (Prospero registration CRD42020176398). Papers with ≥ 50 women, reporting sex specific outcomes, following intact primary AAA repair, from 2000 to 2020 worldwide were included; with separate analyses for EVAR and OAR. Data sources were Medline, Embase, and CENTRAL databases 2005 – 2020 searched using ProQuest Dialog.

Results

Twenty-six studies (371 215 men, 65 465 women) were included. Meta-analysis and meta-regression indicated that sex specific odds ratios (ORs) for 30 day mortality were unchanged from 2000 to 2020. Mortality risk was higher in women for OAR and more so for EVAR (OR [95% CI] 1.49 [1.37 – 1.61]; 1.86 [1.59 – 2.17], respectively) and this remained following multivariable risk adjustment. Transfusion, pulmonary complications, and bowel ischaemia were more common in women after OAR and EVAR (OAR: ORs 1.81 [1.60 – 2.04], 1.40 [1.28 – 1.53], 1.54 [1.36 – 1.75]; EVAR: ORs 2.18 [2.08 – 2.29] 1.44 [1.17 – 1.77], 1.99 [1.51 – 2.62], respectively). Arterial injury, limb ischaemia, renal and cardiac complications were more common in women after EVAR (ORs 3.02 [1.62 – 5.65], 2.13 [1.48 – 3.06], 1.46 [1.22 – 1.72] and 1.19 [1.03 – 1.37], respectively); the latter was associated with greater mortality risk on meta-regression.

Conclusion

Increased mortality risk for women following AAA repair remains. Women had a higher incidence of transfusion, pulmonary and bowel complications after EVAR and OAR. Higher mortality risk ratios for EVAR may result from cardiac complications, additional arterial injury, and embolisation, leading to renal and limb ischaemia. These findings indicate possible causes for observed outcome disparities and targets for quality improvement.

中文翻译：

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编辑推荐 - 开放和血管内完整腹主动脉瘤修复术后不良事件性别差异的系统回顾和荟萃分析：女性的结局一直更差

客观的

此前，有报道表明，在腹主动脉瘤 (AAA) 的选择性开放 (OAR) 和血管内 (EVAR) 修复后，女性的死亡率高于男性。随着近期整体 AAA 修复结果的改善，本研究旨在确定现代实践是否改善了性别差异，并确定了围手术期和术后并发症以及术前状态的性别差异；可能导致不良结果的因素。

方法

这是根据 PRISMA 指南（Prospero 注册 CRD42020176398）对 30 天死亡率和并发症的性别特异性差异进行的系统评价、荟萃分析和荟萃回归。纳入 2000 年至 2020 年全球范围内 ≥ 50 名女性、报告性别特定结果、完整的原发性 AAA 修复后的论文；对 EVAR 和 OAR 进行单独分析。数据源是 Medline、Embase 和 CENTRAL 数据库 2005 – 2020 年，使用 ProQuest Dialog 搜索。

结果

纳入了 26 项研究（371 215 名男性，65 465 名女性）。荟萃分析和荟萃回归表明，从 2000 年到 2020 年，30 天死亡率的性别特异性优势比 (OR) 没有变化。女性的 OAR 死亡率更高，EVAR 更高（OR [95% CI] 1.49 [1.37 – 1.61]；1.86 [1.59 – 2.17]），这在多变量风险调整后仍然存在。输血、肺部并发症和肠缺血在 OAR 和 EVAR 后的女性中更为常见（OAR：ORs 1.81 [1.60 – 2.04]、1.40 [1.28 – 1.53]、1.54 [1.36 – 1.75]；EVAR：ORs 2.18 [2.08 – 2.29] ] 1.44 [1.17 – 1.77]、1.99 [1.51 – 2.62]）。动脉损伤、肢体缺血、肾脏和心脏并发症在 EVAR 后的女性中更为常见（OR 分别为 3.02 [1.62 – 5.65]、2.13 [1.48 – 3.06]、1.46 [1.22 – 1.72] 和 1.19 [1.03 – 1.37]）；

结论

AAA 修复后女性的死亡风险仍然增加。女性在 EVAR 和 OAR 后输血、肺部和肠道并发症的发生率较高。心脏并发症、额外的动脉损伤和栓塞可能导致 EVAR 较高的死亡率风险比，从而导致肾脏和肢体缺血。这些发现表明了观察到的结果差异的可能原因和质量改进的目标。