Tomee SM, et al. - Authors here aimed at determining sex-related differences in the epidemiology of ruptured abdominal aortic aneurysms (AAAs) to establish an intervention threshold for women. As per findings, for elective endovascular AAA repair, the equivalent of the 55-mm intervention threshold in men was 52 mm in women. They observed almost doubled mortality risk for elective open repair in women which indicated that the optimal point for open repair was at higher diameters, very possibly at least 55 mm.

Methods

• In The Netherlands, the Dutch Surgical Aneurysm Audit (DSAA) is a compulsory, nation-wide registry of AAA repairs.
• This analysis included all patients with emergency or elective AAA repair between January 1, 2013, and December 31, 2015.
• For this study, the main outcomes were age, sex, AAA diameter at time of rupture, and 30-day postoperative mortality.

Results

• This analysis included 1561 ruptured AAA repairs (14.7% women) and 7063 cases of elective AAA repair (13.7% women).
• Significantly smaller mean ± standard deviation AAA diameter at time of rupture was observed in women compared to men; 70.5 ± 14.4 mm and 78.6 ± 17.5 mm, respectively.
• 8% of ruptures in male patients, occurred at diameters below the 55 mm intervention threshold.
• As per findings, the female equivalent of this eighth percentile was 52 mm.
• Female patients indicated markedly higher 30-day mortality after emergency repair, namely, 33% for women versus 24.2% for men, but were also significantly older, mean ± standard deviation age 76.7 ± 7.1 years and 73.9 ± 8.3 years for women and men, respectively.
• In this study, correcting for age reduced the 30-day mortality risk for women after ruptured AAA repair from 1.53 (95% confidence interval, 1.14-2.04) to 1.27 (95% confidence interval, 0.92-1.73).
• Significantly worse outcome after open elective repair was observed for women compared with men, with a 30-day mortality of 7.97% for women and 4.27% for men (P < .01).