Sex differences in trends and in-hospital outcomes among patients with critical limb ischemia: A nationwide analysis

Ayman Elbadawi, Kirolos Barssoum, Michael Megaly, Devesh Rai, Ahmed Elsherbeeny, Hend Mansoor, Mehdi H. Shishehbor, Ahmed Abdel-Latif, Martha Gulati, Islam Y. Elgendy

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


BACKGROUND: Critical limb ischemia (CLI) represents the most severe form of peripheral artery disease and is associated with significant mortality and morbidity. Contemporary data comparing the sex differences in trends, revascularization strategies, and in-hospital outcomes among patients with CLI are scarce. METHODS AND RESULTS: Using the National Inpatient Sample database years 2002 to 2015, we identified hospitalizations for CLI. Temporal trends for hospitalizations for CLI were evaluated. The differences in demographics, revascularization, and in-hospital outcomes between both sexes were compared. Among 2 400 778 CLI hospitalizations, 43.6% were women. Women were older and had a higher prevalence of obesity, hypertension, heart failure, and prior stroke. Women were also less likely to receive any revascularization (34.7% versus 35.4%, P<0.001), but the trends of revascularization have been increasing among both sexes. Revascularization was associated with lower in-hospital mortality among women (adjusted odds ratio [OR], 0.76; 95% CI, 0.71– 0.81) and men (adjusted OR, 0.69; 95% CI, 0.65– 0.73). On multivariable analysis adjusting for patient-and hospital-related characteristics as well as revascularization, women had a higher incidence of in-hospital mortality, postoperative hemorrhage, need for blood transfusion, postoperative infection, ischemic stroke, and discharge to facilities compared with men. CONCLUSIONS: In this nationwide contemporary analysis of CLI hospitalizations, women were older and less likely to undergo revascularization. Women had a higher incidence of in-hospital mortality and bleeding complications compared with men. Sex-specific studies and interventions are needed to minimize these gaps among this high-risk population.

Original languageEnglish
Article numbere022043
JournalJournal of the American Heart Association
Issue number18
StatePublished - 2021

Bibliographical note

Publisher Copyright:
© 2021 The Authors.


  • Critical limb ischemia
  • Mortality
  • Revascularization
  • Sex
  • Women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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