Sex Disparity in Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Driven by In-Hospital Treatment Delays

Linda J. Wang, MD, MBA; Satinderjit Locham, MD; Hanaa Dakour-Aridi, MD; Keith D. Lillemoe, MD; Bryan Clary, MD; Mahmoud B. Malas, MD, MHS


Annals of Surgery. 2019;270(4):630-638. 

In This Article


There are several limitations to our analysis. One limitation lies in the retrospective review of a prospectively maintained database, prone to entry errors and missing data; the VQI performs regular audits to minimize these issues. Clinical symptomatology is not included in this database, and thus differences in presentation are unable to be studied. The true time of first medical contact, whether it be an emergency medical personnel or an outside facility provider, is not documented and thus prehospital treatment delays are unable to be evaluated. The complexity of access to health services cannot be fully appreciated in this dataset and further investigation into social barriers to healthcare access are needed. In addition, the VQI is limited in its ability to provide some aneurysm-specific anatomic details such as the presence of aortic thrombus, access vessel size, and certain concomitant procedures. As VQI captures only a percentage of AAA repairs performed in the United States, a selection bias may be present. Finally, even after risk adjustment, there may remain unidentified differences between the groups not accounted for in this analysis.