Menopausal Status and Inpatient Mortality in Medically Managed Type B Acute Aortic Dissection: An Insight from National Inpatient Sample Data(2016-2020)

Background: Type B acute aortic dissection (AAD) is often managed medically, with potential outcome differences by menopausal status due to hormonal and vascular factors. We evaluated the impact of menopausal status on inpatient mortality, length of stay (LOS), and total hospitalization charges. Methods: Using National Inpatient Sample data (2016–2019), we identified 3,533 women with Type B AAD ( excluding if any aortic surgical procedures) via ICD-10-CM codes, comprising 417 premenopausal (<50 years) and 3,116 postmenopausal (≥50 years or any postmenopausal related codes) patients. A 1:1 nearest-neighbor propensity score matching using 20 sociodemographic and clinical covariates mitigated confounders, yielding a balanced cohort of 737 patients (369 per group). The primary outcome was inpatient mortality. Secondary outcomes were LOS and total charges. Logistic regression assessed mortality; Wilcoxon tests compared LOS and charges. Results: The matched cohort had a mean age of 53.5 years and included 44.4% White, 39.0% Black, 8.7% Hispanic, 7.9% Other. Postmenopausal women had higher odds of mortality (odds ratio [OR] 3.11, 95% CI 1.69–5.71, p<0.001) in the matched cohort, consistent with the unmatched cohort (OR 4.59, 95% CI 2.82–7.46, p<0.001). LOS (median 4 vs. 5 days, IQR 6 vs. 6, p=0.956) and charges (median $64,103 vs. $67,020, IQR $114,634 vs. $102,720, p=0.817) were similar for postmenopausal versus premenopausal women. Conclusion: Postmenopausal women with medically managed Type B AAD face significantly higher inpatient mortality, but similar LOS and hospitalization cost, highlighting the need for menopausal status-specific risk stratification.