Sex-Based Differences in Ruptured Abdominal Aortic Aneurysm Management and Outcomes: An Update.

Objectives: This study aimed to evaluate sex-based differences in outcomes following ruptured abdominal aortic aneurysm (AAA) repair, focusing on mortality, morbidity, and postoperative complications.

Design: Retrospective cohort study SETTING: Multi-institutional data from the Vascular Quality Initiative national database, covering a period from January 2003 to December 2022.

Participants: We included 7,548 patients undergoing open or endovascular repair for ruptured AAA: 5,829 men (77.2%) and 1,719 women (22.8%).

Interventions: Patients underwent either open surgical repair or endovascular aneurysm repair for ruptured AAA.

Measurements and main results: Between 2003 and 2022, the rate of mortality decreased significantly for both sexes (57.1% to 31.6% in women and 38.5% to 19.6% in men). Men had a higher incidence of coronary artery disease (22.7% v 17.3%; p < 0.001), more frequent occurrences of prior percutaneous coronary intervention (12.8% v 10.2%; p = 0.004), and previous aneurysm repair (7.2% v 5.3%; p = 0.005) compared with women. Men demonstrated worse cardiovascular (OR 0.82 [0.72-0.94]; p = 0.005) and pulmonary (OR 0.86 [0.73-1.00]; p = 0.025) complications. Women exhibited higher in-hospital mortality (OR 1.27 (1.12-1.44); p < 0.001) and presented at an older age (76.0 years v 71.0 years; p < 0.001), with a higher incidence of hypertension (78.1% v 75.0%; p = 0.008). Women experienced a significantly longer average time from symptom onset to repair (8.00 hours v 7.00 hours; p = 0.002).

Conclusions: Significant sex-based disparities were found in AAA repair outcomes. Men had higher comorbidity burdens while women presented at an older age with an increased time from symptom onset to repair. These findings support the need for sex-specific guidelines and interventions to improve outcomes for both women and men.