Mortality following elective abdominal aortic aneurysm repair in women
Authors: Tedjawirja V. N. , Alberga A. J. , Hof M. H. P. , Vahl A. C. , Koelemay M. J. W. , Balm R. ,   in collaboration with the Dutch Society of Vascular Surgery, van den Akker P.J. , Akkersdijk G.J. , Akkersdijk G.P. , Akkersdijk W.L. , van Andringa de Kempenaer M.G. , Arts C.H.P. , Avontuur J.A.M. , Bakker O.J. , Balm R. , Barendregt W.B. , Bekken J.A. , Bender M.H. , Bendermacher B.L. , van den Berg M. , Berger P. , Beuk R.J. , Blankensteijn J.D. , Bleker R.J. , Blok J.J. , Bode A.S. , Bodegom M.E. , van der Bogt K.E. , Boll A.P.M. , Booster M.H. , Borger van der Burg B.L. , de Borst G.J. , Bos- van Rossum W.T.G.J. , Bosma J. , Botman J.M.J. , Bouwman L.H. , Brehm V. , de Bruijn M.T. , de Bruin J.L. , Brummel P. , van Brussel J.P. , Buijk S.E. , Buijs M.A. , Buimer M.G. , Burger D.H. , Buscher H.C. , Cancrinus E. , Castenmiller P.H. , Cazander G. , Coester A.M. , Cuypers P.H. , Daemen J.H. , Dawson I. , Dierikx J.E. , Dijkstra M.L. , Diks J. , Dinkelman M.K. , Dirven M. , Dolmans D.E. , van Doorn R.C. , van Dortmont L.M. , Drouven J.W. , van der Eb M.M. , Eefting D. , van Eijck G.J. , Elshof J.W. , Elsman B.H. , van der Elst A. , van Engeland M.I. , van Eps R.G. , Faber M.J. , de Fijter W.M. , Fioole B. , Fokkema T.M. , Frans F.A. , Fritschy W.M. , Fung Kon Jin P.H. , Geelkerken R.H. , van Gent W.B. , Glade G.J. , Govaert B. , Groenendijk R.P. , de Groot H.G. , van den Haak R.F. , de Haan E.F. , Hajer G.F. , Hamming J.F. , van Hattum E.S. , Hazenberg C.E. , Hedeman Joosten P.P. , Helleman J.N. , van der Hem L.G. , Hendriks J.M. , van Herwaarden J.A. , Heyligers J.M. , Hinnen J.W. , Hissink R.J. , Ho G.H. , den Hoed P.T. , Hoedt M.T. , van Hoek F. , Hoencamp R. , Hoffmann W.H. , Hogendoorn W. , Hoksbergen A.W. , Hollander E.J. , Hommes M. , Hopmans C.J. , Huisman L.C. , Hulsebos R.G. , Huntjens K.M. , Idu M.M. , Jacobs M.J. , van der Jagt M.F. , Jansbeken J.R. , Janssen R.J. , Jiang H.H. , de Jong S.C. , Jongbloed-Winkel T.A. , Jongkind V. , Kapma M.R. , Keller B.P. , Khodadade Jahrome A. , Kievit J.K. , Klemm P.L. , Klinkert P. , Koedam N.A. , Koelemaij M.J. , Kolkert J.L. , Koning G.G. , Koning O.H. , Konings R. , Krasznai A.G. , Krol R.M. , Kropman R.H. , Kruse R.R. , van der Laan L. , van der Laan M.J. , van Laanen J.H. , van Lammeren G.W. , Lamprou D.A. , Lardenoye J.H. , Lauret G.J. , Leenders B.J. , Legemate D.A. , Leijdekkers V.J. , Lemson M.S. , Lensvelt M.M. , Lijkwan M.A. , Lind R.C. , van der Linden F.T. , Liqui Lung P.F. , Loos M.J. , Loubert M.C. , van de Luijtgaarden K.M. , Mahmoud D.E. , Manshanden C.G. , Mattens E.C. , Meerwaldt R. , Mees B.M. , von Meijenfeldt G.C. , Menting T.P. , Metz R. , Minnee R.C. , de Mol van Otterloo J.C. , Molegraaf M.J. , Montauban van Swijndregt Y.C. , Morak M.J. , van de Mortel R.H. , Mulder W. , Nagesser S.K. , Naves C.C. , Nederhoed J.H. , Nevenzel-Putters A.M. , de Nie A.J. , Nieuwenhuis D.H. , Nieuwenhuizen J. , van Nieuwenhuizen R.C. , Nio D. , Noyez V.J. , Oomen A.P. , Oranen B.I. , Oskam J. , Palamba H.W. , Peppelenbosch A.G. , van Petersen A.S. , Petri B.J. , Pierie M.E. , Ploeg A.J. , Pol R.A. , Ponfoort E.D. , Post I.C. , Poyck P.P. , Prent A. , ten Raa S. , Raymakers J.T. , Reichart M. , Reichmann B.L. , Reijnen M.M. , de Ridder J.A. , Rijbroek A. , van Rijn M.J. , de Roo R.A. , Rouwet E.V. , Saleem B.R. , Salemans P.B. , van Sambeek M.R. , Samyn M.G. , van ’t Sant H.P. , van Schaik J. , van Schaik P.M. , Scharn D.M. , Scheltinga M.R. , Schepers A. , Schlejen P.M. , Schlosser F.J. , Schol F.P. , Scholtes V.P. , Schouten O. , Schreve M.A. , Schurink G.W. , Sikkink C.J. , te Slaa A. , Smeets H.J. , Smeets L. , Smeets R.R. , de Smet A.A. , Smit P.C. , Smits T.M. , Snoeijs M.G. , Sondakh A.O. , Speijers M.J. , van der Steenhoven T.J. , van Sterkenburg S.M. , Stigter D.A. , Stokmans R.A. , Strating R.P. , Stultiëns G.N. , Sybrandy J.E. , Teijink J.A. , Telgenkamp B.J. , Teraa M. , Testroote M.J. , Tha-In T. , The R.M. , Thijsse W.J. , Thomassen I. , Tielliu I.F. , van Tongeren R.B. , Toorop R.J. , Tournoij E. , Truijers M. , Türkcan K. , Tutein Nolthenius R.P. , Ünlü Ç. , Vaes R.H. , Vafi A.A. , Vahl A.C. , Veen E.J. , Veger H.T. , Veldman M.G. , Velthuis S. , Verhagen H.J. , Verhoeven B.A. , Vermeulen C.F. , Vermeulen E.G. , Vierhout B.P. , van der Vijver-Coppen R.J. , Visser M.J. , van der Vliet J.A. , Vlijmen - van Keulen C.J. , Voorhoeve R. , van der Vorst J.R. , Vos A.W. , de Vos B. , Vos C.G. , Vos G.A. , Voute M.T. , Vriens B.H. , Vriens P.W. , de Vries A.C. , de Vries D.K. , de Vries J.P. , de Vries M. , van der Waal C. , Waasdorp E.J. , Wallis de Vries B.M. , van Walraven L.A. , van Wanroij J.L. , Warlé M.C. , van de Water W. , van Weel V. , van Well A.M. , Welten G.M. , Welten R.J. , Wever J.J. , Wiersema A.M. , Wikkeling O.R. , Willaert W.I. , Wille J. , Willems M.C. , Willigendael E.M. , Wilschut E.D. , Wisselink W. , Witte M.E. , Wittens C.H. , Wong C.Y. , Wouda R. , Yazar O. , Yeung K.K. , Zeebregts C.J. , van Zeeland M.L. 
Published: December 2021

Abstract

Background
Previous studies have focused on patient-related risk factors to explain the higher mortality risk in women undergoing elective abdominal aortic aneurysm (AAA) repair. The aim of this study was to evaluate whether hospital-related factors influence outcomes following AAA repair in women.

Methods
Patients undergoing elective AAA repair in 61 hospitals in the Netherlands were identified from the Dutch Surgical Aneurysm Audit registry (2013–2018). A mixed-effects logistic regression analysis was conducted to assess the effect of sex on in-hospital and/or 30-day mortality. This analysis accounted for possible correlation of outcomes among patients who were treated in the same hospital, by adding a hospital-specific random effect to the statistical model. The analysis adjusted for patient-related risk factors and hospital volume of open surgical repair (OSR) and endovascular aneurysm repair (EVAR).

Results
Some 12 034 patients were included in the analysis. The mortality rate was higher in women than among men: 53 of 1780 (3.0 per cent) versus 152 of 10 254 (1.5 per cent) respectively. Female sex was significantly associated with mortality after correction for patient- and hospital-related factors (odds ratio 1.68, 95 per cent c.i. 1.20 to 2.37). OSR volume was associated with lower mortality (OR 0.91 (0.85 to 0.95) per 10-procedure increase) whereas no such relationship was identified with EVAR volume (OR 1.03 (1.01 to 1.05) per 10-procedure increase).

Conclusion
Women are at higher risk of death after abdominal aortic aneurysm repair irrespective of patient- and hospital-related factors.