Abstract 4146674: Sex Differences in Readmissions and Outcomes of Medically-Managed Type B Aortic Dissection

Introduction: Medical management is recommended for patients with acute uncomplicated type B aortic dissection (TBAD), with operative intervention reserved for complicated cases. There is little research focused on sex differences in outcomes in patients with TBAD managed medically. Research Question: What is the impact of patient sex on in-hospital outcomes and readmissions for TBAD in patients who are managed medically? Methods: Hospitalizations of adults with a diagnosis of TBAD were identified using the 2016-2019 Nationwide Readmissions Database. TBAD diagnosis was deduced by inclusion of dissection of thoracic or thoracoabdominal aorta and exclusion of presumed type A aortic dissection based on prior studies. Hospitalizations associated with endovascular or open repair were excluded. Multivariable logistic regression modeling was used to investigate the association of sex with in-hospital mortality. A Cox proportional hazards model was used to assess the association between sex and readmission rates. Results: There were 52,269 TBAD hospitalizations (58% men). Compared to men, women were older (median age 72 vs 65 years), had higher in-hospital mortality (11.5% vs 8.5%), shorter median length of stay (3.95 vs 4.23 days), lower median total charges ($53,461 vs $63,655), and decreased rates of elective admissions (6.4% vs 8.2%) (all p<0.05). Despite similar rates of hypertension, higher rates of atherosclerotic disease and risk factors in men, including coronary artery disease, obesity, and smoking, and decreased rates of hospital-related complications in women, including acute kidney injury, women experienced increased adjusted in-hospital mortality (odds ratio: 1.16; 95% CI, 1.06-1.27). However, there were no sex differences in readmission risk at 30, 90, and 180 days, perhaps reflecting a survivor bias. Conclusions: Women with TBAD who were managed medically experienced higher in-hospital mortality than men despite lower rates of atherosclerotic disease and risk factors. Prior research has demonstrated sex-specific differences in demographics and presenting TBAD clinical characteristics, including older age in women, varied signs/symptoms, and delays in diagnosis in women. We speculate that these features may contribute to the worse immediate outcomes observed in women. Further data are needed to delineate additional causes of adverse acute outcomes in women managed medically, including condition- (imaging and anatomic features) and medication-specific factors.