Evidence for Female Patient Disadvantage after Endovascular Aortic Repair in the Quality Registry of the German Society for Vascular Surgery and Vascular Medicine (DGG).

OBJECTIVE

Sex disparities in outcomes following endovascular aortic repair (EVAR) are well documented globally. This study used registry data to evaluate whether these disparities persist within the decentralised German healthcare system among centres voluntarily participating in quality improvement.

METHODS

This retrospective observational study analysed prospectively collected data from the German Society for Vascular Surgery and Vascular Medicine (DGG) quality registry between January 2017 and December 2023. The cohort included all patients undergoing EVAR for intact (asymptomatic or symptomatic) or ruptured abdominal aortic aneurysm. Multivariable logistic regression was employed to identify independent predictors of both in hospital death and failure to rescue.

RESULTS

Of 19 266 patients included, 2 576 (13.4%) were women. Compared with men, women were significantly older (median 77 years vs. 74 years), more likely to present with symptomatic (17.1% vs. 11.0%) or ruptured aneurysms (6.3% vs. 4.2%), and had more adverse neck anatomy (< 15 mm; 14.2% vs. 10.5%). Women were less likely to receive statin therapy on admission. Post-operatively, women experienced higher failure to rescue (1.9% vs. 1.0%; p < .001) and in hospital mortality rates (3.3% vs. 1.6%; p < .001). In multivariable analyses, female sex remained independently associated with an increased risk of both in hospital death (odds ratio [OR] 1.853, 95% confidence interval [CI] 1.397 - 2.457) and failure to rescue (OR 1.688, 95% CI 1.183 - 2.409).

CONCLUSION

Significant sex based disparities in EVAR management and outcomes persist in Germany, mirroring findings from centralised healthcare systems. Despite treatment in centres dedicated to quality improvement, women face higher mortality and complication rates, suggesting that voluntary quality measures and decentralised structures alone are insufficient to mitigate female patient disadvantage.