Females were 30% less likely to undergo surgery for PAD, national database study finds

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Katharine McGinigle

A review of more than 1 million patients receiving vascular surgery over a 16-year period identified significant sex-related disparities in the treatment of abdominal aortic aneurysms (AAAs) and peripheral arterial disease (PAD)—with females 30% less likely to undergo surgery in the case of PAD.

“The first annual Women’s Vascular Summit highlighted sex- and gender-related knowledge gaps in vascular disease and treatment,” first author Katharine McGinigle, MD, assistant professor in the division of vascular surgery at the University of North Carolina in Chapel Hill, writes in the Journal of Vascular Surgery (JVS) in June. “This finding suggests an opportunity for further research to improve care and outcomes in people who identify as women, specifically.”

Speaking to Vascular Specialist, McGinigle goes into more detail about the meeting and its importance: “The Women’s Vascular Summit, directed by co-author Linda Harris, [MD], is an annual meeting for medical professionals who treat vascular disease in females. For all vascular conditions, the research presented at this meeting has illustrated that there are significant sex-related knowledge gaps. Females tend to have different presenting symptoms than males, present later in the disease course, and are more often misdiagnosed.”

The research team hypothesized that once the diagnosis is made, there also would be differences in the intervention rate and type of intervention performed. The purpose of this study, therefore, was to identify all operations performed for AAA, carotid artery stenosis (CAS), and PAD in the U.S., and to provide data on sex-related disparities in treatment.

Using the Healthcare Cost and Utilization Project National Inpatient Sample, the research team identified all hospitalizations of adult patients (≥18 years old) diagnosed with AAA, CAS, or PAD who underwent vascular surgery from 2000–2016. The authors specify that they used census data and sex-specific population disease prevalence estimates from the National Institute of Health and Agency for Healthcare Research and Quality to calculate the number of U.S. adults with AAA, CAS, and PAD.

McGinigle and colleagues detail that there were 1,021,684 hospitalizations for vascular surgery over the 16-year study period: 13% AAA (21% female, 79% male), 40% CAS (42% female, 58% male), and 47% PAD (42% female, 58% male). Females were older than males at the time of surgery (median age, 71.3 years vs. 69.7 years) and less likely to have private insurance (18% vs. 23%). In addition, minimal differences were seen across race/ethnicity, comorbidities, and hospital characteristics.

After accounting for disease prevalence, the authors report in JVS that females were 25% less likely to undergo surgery for AAA and 30% less likely to undergo surgery for PAD compared with males, were less likely to receive an endovascular procedure compared with open for AAA or CAS, and more likely to receive one for PAD.

McGinigle remarks on these findings: “We know we need to improve AAA screening rates, and now we know that even when the diagnosis is made, we need to be operating more in women. […] It appears as if females are getting more endovascular revascularizations in this study, but we caution that all of the patients in this database are admitted to a hospital, so it is likely that women are just more often getting admitted for complications for a common outpatient procedure. The gender-stratified rates of outpatient treatment are known.

“Shared decision-making around the indication for treatment is important, and in the future it will be interesting to study how females versus males make these decisions, particularly in conditions like claudication where there are not objective parameters for intervention.”

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