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Disparities based on race and sex, including Black race and being a woman, impact presentation, complications, and survival in acute type A aortic dissection.

“Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency requiring urgent surgical intervention,” researchers wrote in The American Journal of Surgery. “A range of factors, including sex and race, have been shown to influence clinical presentation and postoperative outcomes in patients undergoing ATAAD repair.”

Prior research has shown that disparities based on sex, including worse survival rates for women, and race, such as differences in disease patterns and etiologies among Black and White patients, are significant variables in the presentation and management of ATAAD. However, the intersection of sex and race in short- and long-term outcomes after ATAAD is not well understood.

To address this knowledge gap, Ibrahim Sultan, MD, and colleagues evaluated whether race- and sex-based differences affect variations in in-hospital and long-term mortality after ATAAD among 515 patients.

The observational retrospective study was conducted at a high-volume referral aortic center from 2010 to 2021. To reflect the racial composition of the patient population, they categorized the cohort into two primary racial groups: White and Black. The researchers used multivariable regression models to analyze race- and sex-stratified differences in mortality and resource use. The primary end point was mortality. Secondary end points included intraoperative resource use, hospital length of stay, and postoperative complications.

Outcomes Worse for Black Patients

Women presented at a significantly older age with a higher comorbidity burden, particularly Black women, suggesting the importance of sex-specific physiologic considerations in perioperative management, according to the researchers.

In both racial subgroups, women were older than men (White: 68 years vs 61 years [P<0.001]; Black: 58.5 years vs 49 years [P=0.002]). Black women exhibited higher incidence of COPD than Black men (30% vs 7%; P=0.008). They also had a greater frequency of having three or more comorbidities than men (53% vs 32%). The prevalence of high-risk profiles (eg, aortic insufficiency and malperfusion syndrome) was comparable across both sex and racial subgroups.

Black women required more intraoperative blood transfusions than Black men (+4.06 units; 95% CI, –0.21 to 7.9), White men (+4.19 units; 95% CI, 0.93-7.45), and White women (+3.48 units; 95% CI, 0.27-6.70). They also had longer postoperative hospital stays compared with Black men, with a mean difference of 6.3 days (95% CI, 0.2-12.3). Prolonged mechanical ventilation was more common in women than men within both subgroups (White: 33% vs 22% [P=0.03]; Black: 33% vs %18 [P=0.05]).

Overall, in-hospital mortality did not differ considerably by sex and race. However, Black patients experienced worse long-term survival, independent of sex.

“Tailoring postoperative interventions to the unique needs of different demographic groups has the potential to significantly enhance patient care and outcomes, underscoring the importance of a multifaceted perspective in healthcare research and practice,” Dr. Sultan and colleagues wrote.