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Published on: November 30, 2010
Sex-related disparity in surgical mortality among pediatric patients
Thomas S Klitzner1, Maggie Lee, Sandra Rodriguez
1Division of Cardiology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
Insights
Female children undergoing cardiac surgery face an 18% higher mortality risk compared to males. This study highlights gender disparities in pediatric cardiovascular outcomes post-surgery, warranting further investigation into underlying mechanisms.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery Outcomes
- Health Disparities
Background:
- Gender differences in adult cardiovascular outcomes extend to children undergoing congenital heart disease repair.
- Existing research suggests potential disparities in pediatric cardiac surgery outcomes based on sex.
Purpose of the Study:
- To investigate the impact of gender on mortality and other outcomes in children (<18 years) undergoing cardiac surgery.
- To identify if female gender is an independent risk factor for adverse outcomes after pediatric cardiac surgery.
Main Methods:
- Analysis of California statewide hospital discharge data (1989-99) linked to death registry.
- Logistic regression used to assess gender's effect on mortality, controlling for multiple demographic and clinical variables.
- Study included 25,402 pediatric cardiac surgery cases.
Main Results:
- Overall in-hospital mortality was 5.92% (1505 deaths).
- Risk-adjusted analysis revealed females had a significantly higher odds ratio (OR=1.18) for in-hospital and 30-day post-discharge mortality compared to males.
- Females had higher prevalence of comorbidities like Down syndrome and pulmonary hypertension.
Conclusions:
- Female gender is associated with an 18% increased risk of in-hospital and 30-day post-discharge mortality after cardiac surgery in children.
- No significant difference in hospital length of stay was observed between genders.
- The biological or clinical mechanisms driving this increased risk in females require further research.
Background:
It has been reported that gender differences in cardiovascular outcomes found in adults also are present in children who undergo surgical repair for congenital heart disease.
Methods:
California statewide hospital discharge data 1989-99 were used to study outcomes in children <18 years undergoing cardiac surgery. Hospital discharge data were linked to death registry data to study postdischarge death within 30 days of discharge. We used logistic regression to evaluate the effect of gender on mortality controlling for age, race and ethnicity, type of insurance, household income, date and month of surgery, type of admission, hospital case volume, and various types of procedures.
Results:
There were 25 402 cardiac surgery cases with 1505 in-hospital deaths (mortality rate of 5.92%). An additional 37 deaths occurred within 30 days after hospital discharge. Crude mortality rates for males (5.99%) and females (5.84%) were not significantly different. However, fewer neonates were female and females underwent a higher proportion of low-risk procedures than males. Logistic regression revealed that females, compared with males, had a significantly higher odds ratio (OR) for in-hospital mortality (OR = 1.18, P < .01) and overall (up to 30 days post discharge) mortality (OR = 1.18, P < .01). The risk-adjusted length of hospital stay was similar between females and males while charges per hospital day were slightly higher in females than males. The prevalence of Down syndrome, pulmonary hypertension, and failure to thrive were higher in females.
Conclusions:
Female gender is associated with an 18% higher in-hospital and 30-day postdischarge mortality as compared with male gender. There was no difference in length of hospital stay between males and females. The mechanism by which female gender acts as a risk factor requires further investigation.
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