Nationwide analysis of risk factors for in-hospital mortality in patients undergoing abdominal aortic aneurysm repair

BackgroundThere is increasing awareness that women may have worse outcomes following repair of abdominal aortic aneurysm (AAA). The aim of this study was to analyse the association between sex, age and in-hospital mortality after AAA using hospital episode data collected routinely at the nationwide level. MethodsData were extracted from the nationwide statutory Diagnosis Related Group statistics provided by the German Federal Statistical Office. Patients with a diagnosis of intact (non-ruptured) AAA (ICD-10 GM I71.4) and procedure codes (OPS; 2005-2013) for endovascular aneurysm repair (EVAR) (5-38a.1*) or open aneurysm repair (5-384.5, 5-384.7), treated from 2005 to 2013, were included. A multilevel multivariable regression model was applied to adjust for medical risk (using the Elixhauser co-morbidity score), type of procedure, type of admission, and to account for clustering of patients within centres. The primary outcome was in-hospital mortality. ResultsSome 84 631 patients were identified, of whom 10 039 (119 per cent) were women. Women were significantly older than men at admission (median 74 (i.q.r. 69-80) versus 72 (66-77) years; P<0001). EVAR was used less frequently in women (481 versus 547 per cent; P<0001). The in-hospital mortality rate was higher in women, overall (50 versus 31 per cent; relative risk 160, 95 per cent c.i. 145 to 175), and for EVAR (28 versus 15 per cent; RR 190, 160 to 230) and open repair (68 versus 50 per cent; RR 136, 122 to 152). In-hospital mortality increased with age and was highest in patients aged over 80years. In multivariable regression analysis, female sex (RR 120, 107 to 135) and age per 10-year increase (RR 183, 173 to 195) were independent risk factors for higher in-hospital mortality. ConclusionIn Germany, women were older when undergoing AAA repair and were less likely to receive EVAR. Mortality rates were higher in older patients and in women, irrespective of the surgical technique used. Women and elderly at higher risk