• Erik Braatz, Christian Olsson, Magnus Dalén, Susanne J Nielsen, Anders Jeppsson, and Malin Stenman.
• Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. Electronic address: erik.braatz@ki.se.
• J. Thorac. Cardiovasc. Surg. 2024 Oct 11.

ObjectiveThe study objective was to investigate the association between female sex and 30-day mortality and postoperative complications in patients undergoing scheduled proximal thoracic aortic surgery in Sweden.MethodsIn a nationwide population-based cohort study, all patients who underwent scheduled proximal thoracic aortic surgery in Sweden between 2016 and 2020 were included. The primary outcome measure was 30-day mortality. Secondary outcome measures included a combined end point including 30-day all-cause mortality, postoperative new-onset dialysis, perioperative stroke, or a prolonged need of postoperative ventilation (>48 hours). Logistic regression models and propensity score matching were used to estimate the association between female sex and primary and secondary outcomes adjusted for differences in baseline characteristics.ResultsA total of 2000 patients (29% women) were analyzed. The crude 30-day all-cause mortality rate was higher in women compared with men (3.1% vs 1.4%, P < .001). Women were older at the time of surgery (65.6 vs 60.2 years, P < .001) and had more comorbidities and a larger maximum indexed aortic diameter (cm/m body height) at the time of surgery (3.4 ± 0.56 vs 3.0 ± 0.48, P < .001). The adjusted risk for 30-day mortality for women compared with men was not significant (odds ratio, 1.41; 95% CI, 0.70-2.83), and neither was the secondary composite end point (odds ratio, 0.89; 95% CI, 0.62-1.27). The propensity score-matched analysis showed similar results.ConclusionsWomen who underwent proximal thoracic aortic surgery had a 2-fold higher unadjusted 30-day mortality risk, but the mortality risk was not significantly higher when age and comorbidities was taken into consideration.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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