Outcomes in REBOA by Sex: Results From the American Association of Surgery for Trauma (AAST) Aortic Occlusion and Resuscitation for Trauma and Acute Care Surgery (AORTA) Trial

Abstract

Background: Female patients have smaller diameter femoral vessels than men and higher rates of procedural complications for elective vascular surgeries. We investigated sex differences in REBOA outcomes including vascular access complications. Methods: Retrospective data query from the AORTA database for 779 patients who underwent REBOA from 2013 to 2023. Demographics, physiology, and outcomes were examined. Univariable and multivariate analyses were performed. Results: Among 779 patients who received REBOA, 22.6% (n=176) were female, and the mean age was 43.0 (+/-18.0) years. The mean Injury Severity Score (ISS) was 34.0 (±15.0). The mean admission Glasgow Coma Scale (GCS) was 8.2 (±5.3) and systolic blood pressure (SBP) at the time of aortic occlusion (AO) was 66.0 (±33.7) mmHg. Female patients were more likely to sustain blunt trauma (91.1% vs. 74.9%; p<0.001) and had marginally higher ISS (36.5 [±15.7] vs. 33.3 [±14.7]; p=0.06). Female patients had lower GCS at admission (7.3 [±5.1] vs. 8.4 [±5.3]; p=0.019). There were no significant differences in vascular complications including pseudoaneurysm, hematoma, traumatic AV fistula, or distal embolism. Acute kidney injury was more common among males (29.4% vs. 13.6%; p<0.001). Hospital length of stay did not differ significantly (15.6 [±18.3] vs. 18.7 [±24.6] days; p=0.43). There was no difference in hospital mortality (52.3% vs. 47.1%) after accounting for clinical factors in the multivariable regression model (adjusted OR 1.07; 95% CI 0.66-1.73; p=0.78). Discussion: Patients who receive REBOA are critically ill. Female patients who receive REBOA do not have significantly more access-related complications than male patients.