Sex-specific differences in alive hospital discharge following infrarenal abdominal aortic aneurysm repair.

Background and aims: A longer time to alive hospital discharge following infrarenal abdominal aortic aneurysm (AAA) repair is associated with reduced patient satisfaction and increased length of stay, hospital-acquired deconditioning, infection, and costs. This study investigated sex-specific differences in, and drivers of, the rate of alive hospital discharge.

Methods: Examination of UK National Vascular Registry (UK NVR), 2014-19, and Swedish National Patient Registry (SE NPR) elective AAA patients, 2010-18, for endovascular (EVAR) or open aneurysm repair (OAR). Cox models assessed sex-specific difference in the rate of alive hospital discharge, adjusting for co-morbidity, anatomy, standard of care, post-operative complications, and year, with in-hospital death as the competing risk.

Results: A total of 29 751 AAA repairs (UK NVR: EVAR 12 518:1532; OAR 6803:837; SE NPR: EVAR 4234:792; OAR 2638:497, men:women) were assessed. For EVAR, the unadjusted rate of alive hospital discharge was ∼25% lower for women [UK NVR: hazard ratio (HR) 0.75 (0.71-0.80), P < .001; SE NPR: HR 0.75 (0.69-0.81), P < .001]. Following adjustment, the sex-specific HR narrowed but remained significant [UK NVR: HR 0.83 (0.79-0.88), P < .001; SE NPR: HR 0.83 (0.76-0.89), P < .001]. For OAR, the rate of alive hospital discharge was 23%-27% lower for women [UK NVR: HR 0.73 (0.67-0.78), P < .001; SE NPR: HR 0.77 (0.70-0.85), P < .001]. Following adjustment, the sex-specific HR narrowed [UK NVR: HR 0.82 (0.76-0.88), P < .001; SE NPR: HR 0.79 (0.72-0.88), P < .001] but remained significant.

Conclusions: Women have a 25% lower rate of alive discharge after aortic surgery, despite adjustment for pre/peri- and post-operative parameters. Efforts to increase the rate of alive hospital discharge for women should be sought.