Sex-Based Differences in Outcomes After Open Thoracoabdominal Aortic Aneurysm Repair: The Modifying Role of Anemia
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0154
Submission Type:
C. Walton Lillehei Resident Forum
Authors:
Alexander Gregg (1), Katherine Krieger (1), Arnar Ingason (1), Bjorn Redfors (1), Jessica Kim (1), Rachel Heise (1), Francesca Pisano (1), Nathnael Feleke (1), Shamha Shiyam (1), Darin Mak (1), Ezra Shimabenga (1), Andrew Kuzemczak (1), Kwadwo Amoako-Boadu (1), Giovanni Jr Soletti (1), Charles Mack (1), Eilon Ram (1), Christopher Lau (1), Mario Gaudino (1), Leonard Girardi (1)
Institutions:
(1) Weill Cornell Medicine, New York, NY
Submitting Author:
Alexander Gregg
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Weill Cornell Medicine
Co-Author(s):
Katherine Krieger
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Weill Cornell Medicine
Arnar Ingason
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Weill Cornell Medicine
Bjorn Redfors
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Weill Cornell Medicine
Jessica Kim
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Weill Cornell Medicine
Rachel Heise
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Weill Cornell Medicine
Francesca Pisano
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Weill Cornell Medicine
Nathnael Feleke
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Weill Cornell Medicine
Shamha Shiyam
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Weill Cornell Medicine
Darin Mak
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Weill Cornell Medicine
Ezra Shimabenga
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Weill Cornell Medicine
Andrew Kuzemczak
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Weill Cornell Medicine
Kwadwo Amoako-Boadu
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Weill Cornell Medicine
Giovanni Jr Soletti
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Weill Cornell Medicine
*Charles Mack
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Weill Cornell Medicine
Eilon Ram
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Weill Cornell Medicine
*Christopher Lau
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Weill Cornell Medicine
*Mario Gaudino
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Weill Cornell Medicine
*Leonard Girardi
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Weill Cornell Medicine
Presenting Author:
Alexander Gregg
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NYP|Weill Cornell Medicine
Abstract:
Objective: We evaluated the influence of perioperative anemia on sex-stratified outcomes following open thoracoabdominal aortic aneurysm repair (TAAAr).
Methods: This was a retrospective analysis conducted at a tertiary aortic center. All consecutive TAAArs from July 1997 to February 2025 were included. The primary outcome was a composite of in-hospital major adverse events (MAEs), including operative mortality, myocardial infarction (MI), cerebrovascular accident (CVA), postoperative bleeding requiring surgical revision, severe pulmonary dysfunction (tracheostomy or acute respiratory distress syndrome) and new need for dialysis. Causal mediation analysis was performed to quantify the extent to which perioperative anemia accounts for the effect of sex on the risk of MAEs.
Results: This analysis consisted of 780 TAAArs, 40% (312/780) of which were female. Females were older (median 71 years [Interquartile Range (IQR) 63, 77] vs. 64 years [IQR 55, 73], p<0.001), with increased chronic obstructive pulmonary disease (49% [153/312] vs. 38% [177/468], p=0.002) and peripheral vascular disease (31% [96/312] vs. 20% [95/468], p<0.001). Extent distribution was similar between cohorts. Females had lower preoperative hemoglobin (g/dL) (median 11.5 [IQR 10.4, 12.5] vs. 12.5 [IQR 11.0, 13.8] p<0.001) and hematocrit (%) (median 34.5 [IQR 31.7, 37.9] vs. 37.6 [IQR 33.3, 41.0] p<0.001) and lower intraoperative hemoglobin (g/dL) (median 7.5 [IQR 6.8, 8.4] vs. 8.0 [IQR 7.1, 9.0] p<0.001) and hematocrit (%) (median 22.0 [IQR 20.0, 25.0] vs. 23.0 [IQR 21.0, 26.0] p<0.001) nadirs. Females were more likely to experience MAEs than males (24% [74/312] vs. 18% [84/468], p=0.05). On causal analysis, female sex was associated with a 5.9% (Estimate 0.059 95% Confidence Interval [CI]: 0.007-0.112, p=0.02) higher probability of MAE when compared to male sex. Of this total effect, 2.2% (Estimate 0.022 95% CI: 0.011-0.033, p<0.001) was indirectly mediated through lower intraoperative hematocrit nadir. Overall, 36.4% (Estimate 0.364 95% CI 0.100-2.345, p=0.02) of the total causal effect of female sex on the probability of MAE was mediated through differences in intraoperative hematocrit nadir.
Conclusion: Differences in intraoperative anemia are a potent mediator of postoperative mortality and morbidity in females, suggesting a modifiable mechanism for mitigating sex differences in TAAAr outcomes.
Methods: This was a retrospective analysis conducted at a tertiary aortic center. All consecutive TAAArs from July 1997 to February 2025 were included. The primary outcome was a composite of in-hospital major adverse events (MAEs), including operative mortality, myocardial infarction (MI), cerebrovascular accident (CVA), postoperative bleeding requiring surgical revision, severe pulmonary dysfunction (tracheostomy or acute respiratory distress syndrome) and new need for dialysis. Causal mediation analysis was performed to quantify the extent to which perioperative anemia accounts for the effect of sex on the risk of MAEs.
Results: This analysis consisted of 780 TAAArs, 40% (312/780) of which were female. Females were older (median 71 years [Interquartile Range (IQR) 63, 77] vs. 64 years [IQR 55, 73], p<0.001), with increased chronic obstructive pulmonary disease (49% [153/312] vs. 38% [177/468], p=0.002) and peripheral vascular disease (31% [96/312] vs. 20% [95/468], p<0.001). Extent distribution was similar between cohorts. Females had lower preoperative hemoglobin (g/dL) (median 11.5 [IQR 10.4, 12.5] vs. 12.5 [IQR 11.0, 13.8] p<0.001) and hematocrit (%) (median 34.5 [IQR 31.7, 37.9] vs. 37.6 [IQR 33.3, 41.0] p<0.001) and lower intraoperative hemoglobin (g/dL) (median 7.5 [IQR 6.8, 8.4] vs. 8.0 [IQR 7.1, 9.0] p<0.001) and hematocrit (%) (median 22.0 [IQR 20.0, 25.0] vs. 23.0 [IQR 21.0, 26.0] p<0.001) nadirs. Females were more likely to experience MAEs than males (24% [74/312] vs. 18% [84/468], p=0.05). On causal analysis, female sex was associated with a 5.9% (Estimate 0.059 95% Confidence Interval [CI]: 0.007-0.112, p=0.02) higher probability of MAE when compared to male sex. Of this total effect, 2.2% (Estimate 0.022 95% CI: 0.011-0.033, p<0.001) was indirectly mediated through lower intraoperative hematocrit nadir. Overall, 36.4% (Estimate 0.364 95% CI 0.100-2.345, p=0.02) of the total causal effect of female sex on the probability of MAE was mediated through differences in intraoperative hematocrit nadir.
Conclusion: Differences in intraoperative anemia are a potent mediator of postoperative mortality and morbidity in females, suggesting a modifiable mechanism for mitigating sex differences in TAAAr outcomes.
Category:
Adult Cardiac
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