Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis
The Nationwide Inpatient Sample (NIS) was queried for aortic valve replacements conducted between 2003 and 2014. The data on a total of 166,809 patients (37% female) were analyzed with respect to outcomes in men vs. women. Hospital mortality was 40% higher in women than men (5.6% v. 4%, p<0.001). When isolated AVRs were analyzed and propensity-matched, hospital mortality was 14% higher in women than men (3.3% v. 2.9%, p=0.001). The differential outcomes appear to be driven by a distinct risk profile.
I expect correction of the dataset for size of the so called aortic ‘annulus’ to negate the gender bias, similarly to coronary size correction neutralises gender outcomes for CABG.
I am stunned that a paper accepted in JAHA got away with apparently NOT recording valve size (see Limitations) in such a context. Valve metrics are ultra-germane in risk profiling here, dear authors, and a retrospective review of aortic valve treatment should have these data available…. Nationwide Inpatient Sample is essentially a wrong tool to answer the research question, although gender comparison is always a catchy theme…