# When similar is not the same: sex-specific outcomes and risk factors in thoracoabdominal aortic repair

## TL;DR

This study shows that men and women have different risk factors for early mortality after aortic surgery, even though overall outcomes are similar.

## Contribution

The study identifies distinct sex-specific predictors of early mortality in thoracoabdominal aortic repair.

## Key findings

- Women had higher rates of wound infections compared to men before matching.
- Men and women had comparable survival and mortality after propensity score matching.
- Risk factors for early mortality differed significantly between the sexes.

## Abstract

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.

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.

In the initial study population, men had a significantly higher BMI (26.3 vs. 23.1 kg/m2, 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.

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.