Dawkins C; Hollingsworth AC; Milburn S; Cheesman M; Walker P; Mofidi R;

The Journal of cardiovascular surgery [J Cardiovasc Surg (Torino)] 2020 Apr 01. Date of Electronic Publication: 2020 Apr 01.

Background: Vascular Services Quality Improvement Program (VSQIP) was introduced to reduce mortality from elective repair of AAA in the United Kingdom. This study examines the differences in perioperative mortality and postoperative survival between men and women following elective repair of AAAs in the 10 years after implementation of the (VSQIP).
Methods: Consecutive patients who underwent elective repair of AAA between 1stJanuary 2008 and 31st March 2018 were included. All patients were assessed using the nationally agreed VSQIP pathway which involved cardiopulmonary exercise testing as well as contrast enhanced CT scan of aorta and multidisciplinary assessment to plan each treatment. CT scans were examined to assess the morphology of AAA. Patients were stratified by age, gender, AAA morphology and preoperative anaerobic threshold. Postoperative survival was assessed using Kaplan-Meier analysis. Cox regression analysis was used to determine predictors of postoperative mortality.
Results: A total of 702 patients underwent elective repair of AAA of whom 632 were men and 70 were women. The mean age of study cohort was 73.5 years (std. dev: 7.3) and mean AAA diameter was 62 mm (std. dev.: 9.9). Two hundred and forty four patients underwent open repair, 402 underwent standard infra renal Endovascular Aneurysm Repair (EVAR) and 56 underwent complex EVAR with perioperative and 30 day mortality of 1.13%. No significant difference was observed in perioperative/30 day mortality between men and women (χ2=0.06, P=0.81). Anaerobic threshold< 8 (HR: 95%CI: 0.68 (0.51-0.92)), complex aneurysm morphology (HR: 95%CI: 1.7 (1.39-2.19)) risk category (HR: 95%CI: 1.89 (1.48-2.42)) and patients age (HR: 95%CI: 1.41 (1.13-1.89)) were independent risk factor for mortality following repair of AAA, whilst female gender [(HR: 95%CI: 0.89 (0.54-1.48)] and AAA size [(HR: 95%CI: 1.01 (0.84-1.22)] were not. There was no difference in post- operative survival between men and women who underwent elective repair of AAA (Log rank: 1.82 P=0.61).
Conclusions: Following the implementation of VSQIP female gender is no longer a significant risk factor for perioperative mortality or reduced survival following elective repair of large asymptomatic AAA.