PMID- 35257798 OWN - NLM STAT- MEDLINE DCOM- 20220726 LR - 20220814 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 76 IP - 2 DP - 2022 Aug TI - A systematic review and meta-analysis of sex- and gender-based differences in presentation severity and outcomes in adults undergoing major vascular surgery. PG - 581-594.e25 LID - S0741-5214(22)00393-7 [pii] LID - 10.1016/j.jvs.2022.02.030 [doi] AB - BACKGROUND: Studies have investigated the effects of gender on vascular surgery care. However, to the best of our knowledge, no comprehensive synthesis of the literature has been performed on the presentation severity and postoperative outcomes for abdominal aortic aneurysms (AAAs), carotid artery stenosis (CAS), peripheral artery disease (PAD), and type B aortic dissection (TBAD). We conducted a systematic review and meta-analysis of the sex and gender differences in the presentation severity and outcomes for patients who had undergone major vascular surgery. METHODS: The MEDLINE, Embase, and Cochrane CENTRAL databases were searched from their inception to December 2020. All observational studies and randomized controlled trials that had evaluated the gender differences in presentation severity or outcomes for patients who had undergone open or endovascular AAA or TBAD repair, carotid endarterectomy or stenting, or lower extremity bypass or angioplasty were included. The presentation severity was defined as follows: AAA (symptomatic or ruptured vs asymptomatic), carotid artery disease (symptomatic vs asymptomatic), PAD (chronic limb-threatening ischemia [CLTI] vs claudication), and TBAD (complicated vs uncomplicated). The postoperative outcomes included long-term mortality, stroke, amputation, revascularization, and graft and/or stent thrombosis. A random effects model was used to derive the odds ratios (ORs), risk ratios (RRs), and 95% confidence intervals (CIs). RESULTS: A total of 236 studies met the inclusion criteria for our systematic review. Of the 236 studies, 86 (n = 2,099,534 patients), 62 (n = 2,300,888 patients), 28 (n = 2,394,143 patients), and 4 (n = 4525 patients) had evaluated the effects of gender on the outcomes for patients with AAA, CAS, PAD, and TBAD, respectively. The female patients were more likely to have presented with a ruptured AAA (OR, 1.18; 95% CI, 1.09-1.28) and CLTI (OR, 1.10; 95% CI, 1.02-1.19) than were the male patients. The all-cause mortality for those with an AAA (RR, 1.35; 95% CI, 1.20-1.52) and those with PAD (RR, 1.14; 95% CI, 1.05-1.23) was higher for the women. However, the female patients with CAS had had lower all-cause mortality (RR, 0.85; 95% CI, 0.76-0.94). No sex differences were found in the TBAD outcomes. CONCLUSIONS: We found that female patients who had undergone vascular surgery were associated with more severe disease at presentation, with a greater proportion of ruptured AAAs and CLTI. This potentially contributes to the higher mortality rates for female patients with AAAs and PAD compared with male patients. Future studies are needed to evaluate the reasons for these disparities, and greater efforts are required to support women in receiving more timely vascular surgical care. CI - Copyright (c) 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Lee, Michael Ho-Yan AU - Lee MH AD - Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. FAU - Li, Pei Ye AU - Li PY AD - Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. FAU - Li, Ben AU - Li B AD - Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. FAU - Shakespeare, Audrey AU - Shakespeare A AD - Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. FAU - Samarasinghe, Yasith AU - Samarasinghe Y AD - Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. FAU - Feridooni, Tiam AU - Feridooni T AD - Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. FAU - Cuen-Ojeda, Cesar AU - Cuen-Ojeda C AD - Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. FAU - Alshabanah, Lina AU - Alshabanah L AD - Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. FAU - Kishibe, Teruko AU - Kishibe T AD - Health Sciences Library, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. FAU - Al-Omran, Mohammed AU - Al-Omran M AD - Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Electronic address: mohammed.al-omran@unityhealth.to. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20220305 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - *Aortic Aneurysm, Abdominal/surgery MH - *Aortic Rupture/surgery MH - *Carotid Stenosis/diagnostic imaging/etiology/surgery MH - *Endovascular Procedures/adverse effects MH - Female MH - Humans MH - Male MH - *Peripheral Arterial Disease/diagnostic imaging/surgery MH - Risk Factors MH - Sex Factors MH - Treatment Outcome OTO - NOTNLM OT - Abdominal OT - Aortic aneurysm OT - Carotid artery disease OT - Health status disparities OT - Peripheral artery disease OT - Social determinants of health OT - Socioeconomic factors OT - Vascular surgical procedures EDAT- 2022/03/09 06:00 MHDA- 2022/07/27 06:00 CRDT- 2022/03/08 08:44 PHST- 2021/10/20 00:00 [received] PHST- 2022/02/24 00:00 [accepted] PHST- 2022/03/09 06:00 [pubmed] PHST- 2022/07/27 06:00 [medline] PHST- 2022/03/08 08:44 [entrez] AID - S0741-5214(22)00393-7 [pii] AID - 10.1016/j.jvs.2022.02.030 [doi] PST - ppublish SO - J Vasc Surg. 2022 Aug;76(2):581-594.e25. doi: 10.1016/j.jvs.2022.02.030. Epub 2022 Mar 5.