Female sex was not associated with a significant difference in 30-day mortality compared to male sex (12.2% vs 17.1%, p=0.377) after propensity score matching for thoracoabdominal aortic repair.
Cohort (n=311)
No
Does female sex compared to male sex affect mortality and outcomes in patients undergoing open surgical thoracoabdominal aortic repair?
While overall survival following open thoracoabdominal aortic repair is comparable between sexes, the predictors of early mortality differ fundamentally, highlighting the need for sex-specific preoperative risk assessment.
Absolute Event Rate: 12.2% vs 17.1%
p-value: p=0.377
Objective Growing evidence suggests major outcome and risk factor disparities between men and women undergoing cardiovascular surgery. Thus, sex-specific approaches are increasingly being adopted in cardiovascular medicine. However, data on sex-specific outcomes and risk stratification in complex thoracoabdominal aortic repair remain limited. Methods We present a retrospective single-center analysis of 311 consecutive patients, including 99 women (31.8%), who underwent open surgical thoracoabdominal aortic repair between 2000 and 2024. Propensity score matching was performed prior to a comparative analysis of intraoperative parameters, postoperative outcome, and complications, as well as short- and long-term mortality between female and male patients. Results In the initial study population, men had a significantly higher BMI (26.3 vs. 23.1 kg/m 2 , p < 0.001) and greater prevalence of coronary artery disease (37.7% vs. 21.2%, p = 0.004) and hyperlipidemia (27.8% vs. 12.1%, p = 0.002) compared to women. Postoperatively, wound infections were more frequent in women in the unmatched cohort (12.1% vs. 4.3%, p = 0.01), but no sex-related differences in mortality, ICU length of stay, or long-term survival were observed after propensity score matching. Multivariate regression revealed highly distinct predictors of early mortality in each sex: prior cardiac surgery and urgency in men versus hypertension, chronic kidney disease, coronary artery disease, and older age at the time of operation in women. Conclusion Overall outcomes and survival following thoracoabdominal aortic repair were comparable between men and women. However, underlying risk factors for early mortality differed fundamentally between sexes. These findings underscore the importance of a sex-specific preoperative risk assessment in the surgical decision-making process prior to open thoracoabdominal aortic repair.
Helms et al. (2026) conducted a cohort in Thoracoabdominal aortic aneurysm (n=311). Female sex vs. Male sex was evaluated on 30-day mortality (propensity-matched cohort) (p=0.377). Female sex was not associated with a significant difference in 30-day mortality compared to male sex (12.2% vs 17.1%, p=0.377) after propensity score matching for thoracoabdominal aortic repair.