Franziska Heidemann1, Jenny Kuchenbecker1, Frederik Peters1, Artur Kotov1, Ursula Marschall2, Helmut L Hoest2, Laura Acar2, Niveditta Ramkumar3, Philip Goodney3, Eike Sebastian Debus1, Ulrich Rother4, Christian-Alexander Behrendt5. 1. Department of Vascular Medicine, Research Group GermanVasc, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. BARMER, Wuppertal, Germany. 3. The Dartmouth Institute for Health Policy and Clinical Practice, Lcebanon, United States. 4. Department of Vascular Surgery, University Medical Center Erlangen, Germany. 5. Department of Vascular Medicine, Research Group GermanVasc, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: ch.behrendt@uke.de.
Abstract
OBJECTIVE: There are several reports addressing sex disparities in peripheral arterial occlusive disease (PAOD) treatment with inconclusive or even conflicting results. However, most previous studies have neither been sufficiently stratified nor used matching or weighting methods to address severe confounding. This study aims to determine disparities between sexes after percutaneous endovascular revascularisation (ER) for symptomatic PAOD. METHODS: Health insurance claims data of the second-largest insurance fund in Germany, BARMER, were used. A large cohort of patients was composed for analysis including index percutaneous ER of symptomatic PAOD performed between January 1, 2010, and December 31, 2018. The study cohort was stratified by intermittent claudication, ischaemic rest pain, and wound healing disorders. Propensity score matching was used to adjust for confounding through differences between age, treated vessel region, comorbidities, and pharmacological treatment. Sex-related differences regarding cardiovascular event-free survival (CVEFS), amputation-free survival (AFS), and overall survival within five years of surgery were determined using Kaplan-Meier time-to-event curves, log rank test, and Cox regression. RESULTS: In the current study, 50,051 patients (47.2% females) were identified and used to compose a matched cohort of 35,232 patients. Among all strata, female patients exhibited a lower mortality (hazard ratio, HR between 0.69 and 0.90), fewer amputation or death (HR between 0.70 and 0.89), and fewer cardiovascular events or death (HR between 0.78 and 0.91). The association between female sex and improved long-term outcomes was most pronounced in patients suffering from intermittent claudication. CONCLUSIONS: In this propensity score-matched analysis of health insurance claims, we observed a superior CVEFS, AFS, and overall survival during five years of follow-up after percutaneous ER in females with symptomatic PAOD. Future studies should address sex disparities in the open surgical treatment of PAOD to illuminate if the conflicting previous reports may be due to an insufficient stratification of studies.
OBJECTIVE: There are several reports addressing sex disparities in peripheral arterial occlusive disease (PAOD) treatment with inconclusive or even conflicting results. However, most previous studies have neither been sufficiently stratified nor used matching or weighting methods to address severe confounding. This study aims to determine disparities between sexes after percutaneous endovascular revascularisation (ER) for symptomatic PAOD. METHODS: Health insurance claims data of the second-largest insurance fund in Germany, BARMER, were used. A large cohort of patients was composed for analysis including index percutaneous ER of symptomatic PAOD performed between January 1, 2010, and December 31, 2018. The study cohort was stratified by intermittent claudication, ischaemic rest pain, and wound healing disorders. Propensity score matching was used to adjust for confounding through differences between age, treated vessel region, comorbidities, and pharmacological treatment. Sex-related differences regarding cardiovascular event-free survival (CVEFS), amputation-free survival (AFS), and overall survival within five years of surgery were determined using Kaplan-Meier time-to-event curves, log rank test, and Cox regression. RESULTS: In the current study, 50,051 patients (47.2% females) were identified and used to compose a matched cohort of 35,232 patients. Among all strata, female patients exhibited a lower mortality (hazard ratio, HR between 0.69 and 0.90), fewer amputation or death (HR between 0.70 and 0.89), and fewer cardiovascular events or death (HR between 0.78 and 0.91). The association between female sex and improved long-term outcomes was most pronounced in patients suffering from intermittent claudication. CONCLUSIONS: In this propensity score-matched analysis of health insurance claims, we observed a superior CVEFS, AFS, and overall survival during five years of follow-up after percutaneous ER in females with symptomatic PAOD. Future studies should address sex disparities in the open surgical treatment of PAOD to illuminate if the conflicting previous reports may be due to an insufficient stratification of studies.
Authors: Xavier Philip Fowler; Barbara Gladders; Kayla Moore; Jialin Mao; Art Sedrakyan; Philip Goodney Journal: BMJ Surg Interv Health Technol Date: 2022-10-07