Sex differences in 277,168 arterial vascular surgical procedures: an 18-year comprehensive analysis of the Brazilian public health system

BackgroundSex-based disparities in the presentation and outcomes of arterial vascular procedures are well-documented in high-income countries. However, comprehensive analyses within low- and middle-income healthcare systems, such as Brazils, are lacking. This study aimed to investigate these disparities using nationwide data from the Brazilian public health system. MethodsA retrospective, nationwide analysis was conducted using data from the DATASUS repository from 2007 to 2024. It included 277,168 hospitalizations for 22 arterial vascular surgical procedures. Outcomes assessed included patient demographics, procedure frequency, age at intervention, in-hospital mortality, length of stay, and the need for intercity or interstate travel for care. ResultsAmong 277,168 procedures, men underwent 60% of all interventions. Women were significantly older at the time of peripheral arterial interventions, while men were older for aortic and carotid procedures. Women had significantly higher mortality rates in 8 out of 22 procedures, particularly in endovascular interventions (e.g., aortoiliac stenting and extremity angioplasty. Men demonstrated a greater need to travel for surgical care, with significant differences in 14 procedures for intercity travel, and only one procedure for interstate travel (difference of approximately 1%). Regional analysis revealed the Southeast as the primary hub for specialized care, receiving patients from all other regions. ConclusionThis 18-year comprehensive analysis reveals sex-based disparities in arterial vascular care within the Brazilian public health system. Men predominated in procedure volume and required more travel for care. Women presented at an older age for peripheral interventions and experienced higher mortality in specific procedures.