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Published on: March 27, 2018
Gender differences in outcomes after off-pump coronary artery bypass graft surgery
Snehal Patel1, J Michael Smith, Amy M Engel
1Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio 45220, USA.
Insights
Women undergoing off-pump coronary artery bypass grafting (CABG) experienced longer hospital stays and more sternal wound complications than men. However, operative mortality rates were similar between sexes after this cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes Research
- Gender Differences in Medicine
Background:
- Off-pump coronary artery bypass grafting (CABG) is a significant cardiac surgical procedure.
- Understanding gender-specific outcomes in CABG is crucial for optimizing patient care.
- Previous studies have shown varied results regarding sex differences in CABG outcomes.
Purpose of the Study:
- To compare surgical outcomes between male and female patients undergoing off-pump CABG.
- To identify potential risk factors influencing these outcomes.
- To analyze the impact of gender on hospitalization length, complications, and mortality.
Main Methods:
- Prospective data collection from a 10-year hospitalization cohort (n=11,230).
- Inclusion criteria: off-pump CABG-only procedure.
- Analysis of 14 confounding risk factors and 14 outcome variables using logistic regression.
Main Results:
- Significant differences in risk factors: men were younger, had larger body surface area, higher creatinine, required more grafts, and had higher rates of cerebrovascular history and tobacco use.
- After adjusting for confounders, women had significantly longer hospitalizations (OR 1.97) and more sternal wound complications (OR 1.07).
- Women showed a trend towards lower operative mortality (0.8% vs. 1.5%), though not statistically significant.
Conclusions:
- Women undergoing off-pump CABG face longer hospitalizations and increased sternal wound complication rates compared to men.
- Despite these differences, operative mortality was comparable between genders.
- Further research may explore the underlying reasons for these gender-specific disparities in recovery and complications.
Abstract:
Our objective was to assess surgical outcomes between male and female patients undergoing off-pump coronary artery bypass grafting (CABG). The study was conducted from a 10-year hospitalization cohort (n = 11,230) in which the data were collected prospectively. Inclusion criteria included an off-pump CABG-only procedure. There were 526 men and 250 women included in the study. Fourteen potential confounding risk factors and 14 outcome variables were examined. Six potential risk factors were found to be significantly different between men and women. Men were younger (P = 0.014), had a larger body surface area (P < 0.001), a higher creatinine level (P < 0.001), required more grafts (P < 0.001), and were more likely to have a cerebrovascular history (P = 0.020) and a history of tobacco use (P < or = 0.001). Logistic regression analysis showed that even after controlling for age, body surface area, creatinine level, number of grafts, and tobacco history, women had longer length of hospitalization (odds ratio, 1.97; 95% confidence interval, 1.28-3.04, P = 0.002) and more sternal wound complications than men (odds ratio, 1.07; 95% confidence interval, 1.01-2.11, P = 0.028) after off-pump CABG. Although not statistically different, women had lower operative mortality than men after off-pump CABG (0.8% [2 of 10] compared with 1.5% [8 of 10], respectively). Despite women requiring a longer hospitalization and having a greater incidence of sternal wound infections than men, there was no significant difference in mortality.
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