Impact of patient sex on selection for abdominal aortic aneurysm repair: a discrete choice experiment
Objectives Women with an abdominal aortic aneurysm (AAA) are less likely to receive elective repair than men. This study explored the effect of patient sex and other attributes on vascular surgeons’ decision-making for infrarenal AAA repair.Design Discrete choice experiment.Setting Simulated environ...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-02-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/2/e091661.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850284808722186240 |
|---|---|
| author | Linda Sharples Anna Louise Pouncey Colin Bicknell Mandy Ryan Luis Enrique Loría-Rebolledo Janet Powell |
| author_facet | Linda Sharples Anna Louise Pouncey Colin Bicknell Mandy Ryan Luis Enrique Loría-Rebolledo Janet Powell |
| author_sort | Linda Sharples |
| collection | DOAJ |
| description | Objectives Women with an abdominal aortic aneurysm (AAA) are less likely to receive elective repair than men. This study explored the effect of patient sex and other attributes on vascular surgeons’ decision-making for infrarenal AAA repair.Design Discrete choice experiment.Setting Simulated environment using case scenarios with varying patient attributes.Participants Vascular surgeons.Interventions Surgical decision-making.Main outcome measures AAA repair versus no repair and endovascular versus open repair.Results 182 surgeons completed 2987 scenarios. When all other attributes were equal, a woman was more likely to be offered an AAA repair (marginal rate of substitution (MRS) 3.86 (95% CI 2.93, 4.79)), while very high anaesthetic risk (MRS −4.33 (95% CI –5.63, –3.03)) and hostile anatomy (MRS −3.28 (95% CI –4.55, –2.01)) were deterrents. Increasing age did not adversely affect the likelihood of offering repair to men but decreased the likelihood for women, which negated women’s selection advantage from the age of 83 years. Women were also more likely to be offered endovascular repair (MRS 2.57 (95% CI 1.30, 3.84)).Conclusions Patient sex alone did not account for real-world disparity observed in selection for surgery. Rather, being a woman was associated with a higher likelihood of being offered AAA repair but also a higher likelihood of being offered less invasive endovascular repair. Increased age decreased the likelihood of surgical selection for women but not men. Preference for less invasive repair, combined with inferior rates of anatomical suitability, and the comparably older age of women at the time of AAA repair selection may account for lower rates of repair for women observed. |
| format | Article |
| id | doaj-art-4712dd9411a143a982adf197bbb2008a |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-4712dd9411a143a982adf197bbb2008a2025-08-20T01:47:28ZengBMJ Publishing GroupBMJ Open2044-60552025-02-0115210.1136/bmjopen-2024-091661Impact of patient sex on selection for abdominal aortic aneurysm repair: a discrete choice experimentLinda Sharples0Anna Louise Pouncey1Colin Bicknell2Mandy Ryan3Luis Enrique Loría-Rebolledo4Janet Powell53 Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK1 Department of Surgery and Cancer, Imperial College London, London, UK1 Department of Surgery and Cancer, Imperial College London, London, UK4 Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK2 Health Economics Research Unit, University of Aberdeen, Aberdeen, UK5 Imperial College London, London, UKObjectives Women with an abdominal aortic aneurysm (AAA) are less likely to receive elective repair than men. This study explored the effect of patient sex and other attributes on vascular surgeons’ decision-making for infrarenal AAA repair.Design Discrete choice experiment.Setting Simulated environment using case scenarios with varying patient attributes.Participants Vascular surgeons.Interventions Surgical decision-making.Main outcome measures AAA repair versus no repair and endovascular versus open repair.Results 182 surgeons completed 2987 scenarios. When all other attributes were equal, a woman was more likely to be offered an AAA repair (marginal rate of substitution (MRS) 3.86 (95% CI 2.93, 4.79)), while very high anaesthetic risk (MRS −4.33 (95% CI –5.63, –3.03)) and hostile anatomy (MRS −3.28 (95% CI –4.55, –2.01)) were deterrents. Increasing age did not adversely affect the likelihood of offering repair to men but decreased the likelihood for women, which negated women’s selection advantage from the age of 83 years. Women were also more likely to be offered endovascular repair (MRS 2.57 (95% CI 1.30, 3.84)).Conclusions Patient sex alone did not account for real-world disparity observed in selection for surgery. Rather, being a woman was associated with a higher likelihood of being offered AAA repair but also a higher likelihood of being offered less invasive endovascular repair. Increased age decreased the likelihood of surgical selection for women but not men. Preference for less invasive repair, combined with inferior rates of anatomical suitability, and the comparably older age of women at the time of AAA repair selection may account for lower rates of repair for women observed.https://bmjopen.bmj.com/content/15/2/e091661.full |
| spellingShingle | Linda Sharples Anna Louise Pouncey Colin Bicknell Mandy Ryan Luis Enrique Loría-Rebolledo Janet Powell Impact of patient sex on selection for abdominal aortic aneurysm repair: a discrete choice experiment BMJ Open |
| title | Impact of patient sex on selection for abdominal aortic aneurysm repair: a discrete choice experiment |
| title_full | Impact of patient sex on selection for abdominal aortic aneurysm repair: a discrete choice experiment |
| title_fullStr | Impact of patient sex on selection for abdominal aortic aneurysm repair: a discrete choice experiment |
| title_full_unstemmed | Impact of patient sex on selection for abdominal aortic aneurysm repair: a discrete choice experiment |
| title_short | Impact of patient sex on selection for abdominal aortic aneurysm repair: a discrete choice experiment |
| title_sort | impact of patient sex on selection for abdominal aortic aneurysm repair a discrete choice experiment |
| url | https://bmjopen.bmj.com/content/15/2/e091661.full |
| work_keys_str_mv | AT lindasharples impactofpatientsexonselectionforabdominalaorticaneurysmrepairadiscretechoiceexperiment AT annalouisepouncey impactofpatientsexonselectionforabdominalaorticaneurysmrepairadiscretechoiceexperiment AT colinbicknell impactofpatientsexonselectionforabdominalaorticaneurysmrepairadiscretechoiceexperiment AT mandyryan impactofpatientsexonselectionforabdominalaorticaneurysmrepairadiscretechoiceexperiment AT luisenriqueloriarebolledo impactofpatientsexonselectionforabdominalaorticaneurysmrepairadiscretechoiceexperiment AT janetpowell impactofpatientsexonselectionforabdominalaorticaneurysmrepairadiscretechoiceexperiment |