What is the clinical evidence from this study?

Study design: Cohort. Population: Acute type A aortic dissection (AAAD) (n=1137). Intervention: Male sex vs. Female sex. Primary outcome: In-hospital mortality (p=0.803).

October 10, 2024Open Access

Sex-related differences in clinical characteristics and in-hospital outcomes of patients in acute type A aortic dissection

Key Result

In-hospital mortality rates were similar between male and female patients undergoing surgery for acute type A aortic dissection (11.1% vs. 10.6%, P=0.803).

Study Design

Type

Cohort (n=1,137)

Multicenter

Structured PICO

Does sex affect in-hospital mortality and clinical outcomes in patients undergoing surgery for acute type A aortic dissection?

Population

1,137 adults (age ≥18 years) undergoing surgery for acute type A aortic dissection (AAAD) with symptom onset within 14 days, mean age 51.98 (males) and 55.16 (females), 75.9% male, based in China. Excluded: unclear record of symptom onset time, traumatic dissection, asymptomatic aortic dissection, history of malignant tumors, coronary artery dissection.

Intervention

Female sex (in the context of undergoing surgery for acute type A aortic dissection under cardiopulmonary bypass)

Comparator

Male sex (in the context of undergoing surgery for acute type A aortic dissection under cardiopulmonary bypass)

Outcome

In-hospital mortality (patient discharge or in-hospital death)hard clinical

In patients undergoing surgery for acute type A aortic dissection, in-hospital mortality is similar between sexes, but females experience more postoperative arrhythmias while males experience more acute kidney injury and gastrointestinal hemorrhage.

Main Result

Absolute Event Rate: 11.1% vs 10.6%

p-value: p=0.803

Limitations

Retrospective study conducted at a single center
Neurological complications examined were limited to stroke and epilepsy, with no data available on the incidence of delirium
Possibility of residual or unknown confounding factors

Abstract

OBJECTIVE: The aim of this study was to investigate sex-related differences in the clinical characteristics and hospital outcomes of patients undergoing surgery for acute type A aortic dissection (AAAD). METHODS: This study was a retrospective study. Patients who underwent surgery for AAAD at the Department of Cardiac Surgery, Fujian Medical University Union Hospital, from January 2014 to March 2023 were consecutively included. Data was extracted from electronic medical records. The primary outcome measure was in-hospital mortality, and secondary outcome measures included new-onset postoperative arrhythmia (POA), acute kidney injury (AKI), hepatic dysfunction, neurological complications, gastrointestinal hemorrhage, ICU length of stay, and hospital length of stay. Patients were divided into two groups based on sex, and data analysis was performed using SPSS 25.0 software. RESULTS: A total of 1137 subjects were included, with 863 males (75.9%) and 274 females (24.1%). There were statistically significant differences in age and BMI between the two groups (P 0.05). The rate of POA in females was 4.7%, higher than in males (2.2%), but AKI and gastrointestinal hemorrhage were both higher in males than in females (P < 0.05). Multivariate analysis showed that age, white blood cell (WBC) counts, lactic acid, operation duration and prolonged mechanical ventilation (PMV) increased the risk of in-hospital mortality in male patients. Hypertension, WBC counts, lactic acid, and PMV increased the risk of in-hospital mortality in female patients. CONCLUSION: Despite significant baseline characteristic differences between male and female AAAD patients, there were no significant differences in onset symptoms. The in-hospital mortality rates were similar between male and female patients, but the risk factors for in-hospital mortality differed.

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