Background: It has been suggested that aortic aneurysms were more common in men than women. But few studies have been reported that women with aortic disease have worse outcomes, are less likely to undergo surgical repair and have higher morbidity and mortality. This study aimed to define the local clinical profile and presentation of Filipino women with aortic aneurysm, and explore whether in-hospital outcomes in Filipino women with aortic aneurysm significantly differ with men.
Methods: This is a retrospective cohort study to determine the gender difference in the clinical profile and in-hospital outcomes of women with aortic aneurysm. The researcher analyzed the demographics, comorbidities, characteristics of aneurysm and the management of patients. Results were compared using independent t test and chi-square test. A p value <0.05 was considered statistically significant. Logistic regression was used to assess the relationship between gender and in-hospital outcomes. Receiver operating characteristic (ROC) analysis was performed to determine the cut-off value for the aortic size that is predictive of the different in-hospital outcomes.
Results: Data analyzed in this study shows that 19% of the 229 aortic aneurysm patients admitted at PHC from 2012 to 2015 were women with male-to-female ratio of 4.2:1. The mean age of presentation of for women is 69±10 years with no significant difference in their male counterparts (men: 66±9 years, p=0.075). Infrarenal abdominal aorta was still the most commonly involved site between genders with higher incidence observed among men (men: 72% versus women: 57%, p=0.069) likely due to the significant increase in tobacco use (women: 11% versus men: 87%, p=<0.001), dyslipidemia (women: 50% versus men: 70%, p=<0.008) and COPD (women: 7% versus men: 23%, p=<0.012) among men, which are risk factors associated with atherosclerotic aortic aneurysms. Among women, the next most commonly involved segment was the descending aorta, which are the vulnerable site for mycotic aneurysms, tuberculous aortitis, aneurysms involved vasculitides and connective tissue disease. Woman who chose a more conservative treatment was at risk for in-hospital mortality (100%), and generally female patients died were younger than male counter parts (55 years vs 64 years). Women who died after surgical repair were relatively older compared to their male counterpart (73 years versus 68 years) and mortality among operated women were significantly associated with increased rate of perioperative infection (78% versus 49%, p=0.003). Data analyzed in this study shows that the over-all rate of rupture is generally higher at 31% (n=72) than the reported 10% rate of rupture in Hongkong. The mortality is uniquely lower at a rate of 31%, which is in variance (lower) with the reported 78% mortality rate of ruptured aneurysms in Hongkong. No significant gender difference exists in the rate of rupture and mortality from aortic rupture in this study. Lastly, this study analyzed that an aortic size of 8.0 cm in women is highly accurate in predicting of embolic and cerebrovascular event with a sensitivity of 100% and specificity of 70%. On the other hand, an aortic size of 7.0 cm in women can be a good predictor of in-hospital mortality, cardiovascular events, and respiratory failure.
Conclusion: This study shortly highlights the existence of the gender differences in the local clinical profile, presentation and the in-hospital outcomes of Filipino women with aortic aneurysm. Knowledge regarding the existence of this gender differences will be useful in the future care of women with aortic aneurysm.