Nasim Hedayati, Ann Brunson, Chin-Shang Li, Aaron C. Baker, William C. Pevec, Patrick S. Romano
Surgery, University of California, Davis, Sacramento, CA.
OBJECTIVES: In recent years, use of endovascular procedures for peripheral arterial disease (PAD) has exceeded use of bypass procedures. Previously, it has been demonstrated that female gender negatively affects the outcomes of PAD interventions. This study examined gender disparities in outcomes of endovascular procedures in a contemporary large population based study.
METHODS: We used the Patient Discharge Data (PDD) from California’s Office of Statewide Health Planning and Development (OSHPD) to identify all patients >35 years of age who underwent PAD interventions during 2005-2009. Cox proportional hazard regression was used to compare amputation-free survival and logistic regression was used to compare 12-month re-intervention rate adjusting for age, race, insurance status, severity of illness, and co-morbidities. Two-sided Fisher's exact test was used for comparison of critical limb ischemia between the sexes.
RESULTS: During 2005-2009, 41,407 individuals underwent PAD interventions, 25,635 (61.9%) of whom had endovascular procedures [11,389 women (44.2%) and 14,246 men]. Women were more likely than men (34.5% vs. 30.1.%, p <0.0001) to present with critical limb ischemia. Although 12-month re-intervention rate in women was similar to men (OR 0.961(95% CI 0.91-1.01, p=0.146), amputation-free survival was better among women than men (HR 0.841, 95% CI 0.761-0.93, p=0.007) following endovascular procedures. Sex was not statistically associated with amputation-free survival following open procedures (HR 1.04, 95% CI 0.94-1.151, p=0.444).
CONCLUSIONS: Despite presenting more frequently with critical limb ischemia, women had better amputation-free survival than men following endovascular PAD procedures in this contemporary population-based study. Further research is essential to help guide current practices of PAD management and address if these outcomes favor one type of PAD treatment modality in women.
AUTHOR DISCLOSURES: A. C. Baker, Nothing to disclose; A. Brunson, Nothing to disclose; N. Hedayati, Nothing to disclose; C. Li, Nothing to disclose; W. C. Pevec, Nothing to disclose; P. S. Romano, Nothing to disclose.
Posted April 2012