Sex- and Age-specific Outcomes After Ruptured Abdominal Aortic Aneurysm Repair

BACKGROUND: Ruptured abdominal aortic aneurysm (RAAA) remains a medical catastrophe. Although early outcomes improved, contemporary data integrating early and long-term survival, and postdischarge care needs across sex- and age groups is limited. METHODS: This nationwide cohort included Dutch RAAA repairs between 2014 and 2023. Dutch Surgical Aneurysm Audit data were linked to Statistics Netherlands registries. Outcomes included 90-day mortality, long-term survival, and postdischarge care. RESULTS: Of the 3642 patients, 15.2% were women, who were older (76.3 vs. 74.0 y) and more often required open repair (61.4% vs. 54.0%). Ninety-day mortality increased with age and was higher in women (39.1% vs. 29.1%), but female sex was not independently associated with early mortality after adjustment.Among 90-day survivors, absolute long-term survival was similar, but relative survival was lower in women (5-year relative survival 68.0% vs. 78.3%). Women were less often discharged home (42.4% vs. 56.7%) and more frequently required early homecare (47.7% vs. 34.7%). Reinterventions were more common after EVAR than open repair and occurred less frequently in women. CONCLUSION: In this nationwide linked audit-registry analysis, outcomes after RAAA repair improved substantially, despite lower estimated in-hospital turndown rates than in earlier eras. The higher early mortality in women reflected by differences in age, presentation severity, and repair type, possibly reflecting less favorable aneurysm anatomy. Female sex also associated with an increased long-term excess mortality and greater postdischarge dependency. These findings indicate that optimization of care for women with a RAAA is not confined to perioperative mortality, but extends across the entire care pathway.