Analysis of gender-related differences in lower extremity peripheral arterial disease
Presented at the Thirty-fourth Annual Spring Peripheral Vascular Surgical Society Meeting, Denver, Colo, June 11-14, 2009.
Received 29 June 2009; accepted 6 September 2009. published online 18 December 2009.
Introduction
Gender-related differences continue to challenge the management of lower extremity (LE) peripheral arterial disease (PAD) in women. We analyzed the time-trends in hospital care of such differences.
Methods
Data for patients with PAD from New York, New Jersey, and Florida state hospital inpatient discharge databases (1998-2007) were analyzed using univariate and multivariate regression analyses.
Results
The 2.4 million PAD-related inpatient discharge records analyzed showed a slight decrease of inpatient procedures for both genders. Compared with men, women had 18% to 27% fewer PAD and 33% to 49% fewer vascular procedural hospitalizations (P < .0001). They were persistently more likely than men to be admitted emergently (56% vs 51% in 1998 and 57% vs 53% in 2007) and discharged to a nursing home. During the study period, the amputation rate declined by 36% in women and 21% in men with PAD, and similarly, open procedures decreased by 36% and 30%. Endovascular procedures, however, increased by 150% in women and 144% in men. Procedural mortality was 4.95% vs 4.37% for men (P < .0001). Female mortality rates were persistently higher after amputations (9.89 % vs 8.90%, P < .0001), open (5.49% vs 4.00%, P < .0001), and endovascular procedures (2.87% vs 2.10%, P < .0001). Time trends showed improved mortality for men and women, with a stable difference between the two.
Conclusion
The analysis of representative state administrative databases of inpatient care records demonstrated improvements in mortality and amputation rates over time. However, a gender-related disparity in PAD outcomes remains that merits further investigation.
aDepartment of Health Evidence and Policy, Mount Sinai Medical Center, New York, NY
bDivision of Vascular Surgery, Mount Sinai Medical Center, New York, NY
Reprint requests: Ageliki G. Vouyouka, MD, FACS, Division of Vascular Surgery, Mount Sinai Medical Center/School of Medicine, 5 E 98th St, Box 1273, New York, NY 10029
Competition of interest: Dr Marin is consulting for Medtronic.
Additional material for this article may be found online at www.jvascsurg.org.
The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.
ABSTRACT