Sex-specific outcomes after thoracic aortic surgery

The impact of sex on quality of life (QoL) and long-term mortality after thoracic aortic surgery is incompletely understood. We investigated whether sex-related differences in these outcomes exist after surgery.

Patients undergoing thoracic aortic surgery between 2004 and 2023 were identified using the Manitoba Thoracic Aortic Database, which was linked to population-level registries in the Manitoba Centre for Health Policy. Inverse probability treatment weighting was performed to account for the differences in baseline characteristics between sexes. The outcomes were survival and surrogate measures of QoL, which were disability (composite of stroke, long-term care admission, or hospital admission ≥3 episodes) and days alive and out of hospital. Post-aortic surgery survival was compared with the age- and sex-matched general population.

There were 1065 patients identified, 25% of whom were female (n = 261). Female patients were older and had greater weighted Charlson Comorbidity Index scores. At 15 years, survival (31% vs 39%) and freedom from disability (53% vs 65%) were lower in female patients. The risk of disability and mortality was greater in female patients (hazard ratio, 1.34; 95% confidence interval, 1.10-1.63). Post-aortic surgery survival was lower than the age- and sex-matched general population. Female patients had lower days alive and out of hospital at 30 (17 [0-22] days vs 20 [11-24] days, P < .001), 90 (76 [54-82] days vs 80 [70-83] days, P < .001), and 180 days (167 [142-172] days vs 170 [158-173] days, P = .001).

Female patients have worse survival and QoL after thoracic aortic surgery. Further research exploring reasons for this disparity is needed to develop sex-specific strategies for the management of thoracic aortic disease.