Systematic review and meta-analysis of sex differences in outcome after intervention for abdominal aortic aneurysm

Background: The aim of this study was to assess possible differences in mortality between men and women with an abdominal aortic aneurysm (AAA) treated either by elective repair or following aneurysm rupture. Methods: A systematic literature search was performed using the MEDLINE, Cochrane and Embase databases. Data were analysed by means of bivariate random-effects meta-analysis. Data were pooled and odds ratios (ORs) calculated for women compared with men. Results: Sixty-one studies (516 118 patients) met the predetermined inclusion criteria. Twenty-six reported on elective open AAA repair, 21 on elective endovascular repair, 25 on open repair for ruptured AAA and one study on endovascular repair for ruptured AAA. Mortality rates for women compared with men were 7.6 versus 5.1 per cent (OR 1.28, 95 per cent confidence interval (c.i.) 1.09 to 1.49) for elective open repair, 2.9 versus 1.5 per cent (OR 2.41, 95 per cent c.i. 1.14 to 5.15) for elective endovascular repair, and 61.8 versus 42.2 per cent (OR 1.16, 95 per cent c.i. 0.97 to 1.37) in the group that had open repair for rupture. The group that had endovascular repair for ruptured AAA was too small for meaningful analysis. Conclusion: Women with an AAA had a higher mortality rate following elective open and endovascular repair.