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Gender's impact on outcome in coronary surgery with minimized extracorporeal circulation
Michael Ried1, Dirk Lunz, Reinhard Kobuch
1Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. micha.ried@t-online.de
Insights
Female gender is not an independent risk factor for in-hospital mortality after coronary artery bypass grafting (CABG) using minimized extracorporeal circulation (MECC). However, disparities persist, highlighting the need to address modifiable risk factors in female cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Statistics
Background:
- The impact of female gender on cardiac surgery outcomes remains debated.
- This study investigates gender differences in mortality following coronary artery bypass grafting (CABG) utilizing minimized extracorporeal circulation (MECC).
Purpose of the Study:
- To determine if female gender is an independent risk factor for mortality after CABG with MECC.
- To analyze gender-specific outcomes and identify contributing factors to mortality disparities.
Main Methods:
- Retrospective analysis of 1,662 patients (439 females, 1,223 males) who underwent CABG with MECC between 2004 and 2009.
- Primary endpoint was in-hospital mortality, with risk-adjusted mortality calculated using logistic regression.
Main Results:
- Unadjusted mortality was higher in women (5.7%) compared to men (2.3%).
- Risk-adjusted analysis revealed female gender was not an independent predictor of mortality (OR 1.6).
- Low body surface area (<1.66 m²) was associated with increased mortality in females.
Conclusions:
- Gender-related outcome disparities persist after MECC-assisted CABG.
- Female gender itself is not an independent risk factor for in-hospital mortality.
- Focusing on modifiable risk factors is crucial for improving outcomes in female cardiac surgery patients.
Background:
The role of female gender in cardiac surgery is still controversial. We examined the impact of gender on mortality after coronary artery bypass grafting (CABG) with minimized extracorporeal circulation (MECC).
Methods:
Between January 2004 and May 2009, 1,662 patients (439 females, 1,223 males) underwent CABG with MECC at the University Medical Center Regensburg. Perioperative data were retrospectively analyzed; primary end point was in-hospital mortality.
Results:
At operation, women were older, had a higher prevalence of diabetes and impaired renal function, and underwent more often non-elective surgery. Unadjusted mortality was significantly lower for men and than for women (2.3 vs. 5.7%; p = 0.001). Risk-adjusted mortality rates were derived by stepwise logistic regression. The final model reduced the gender-related mortality gap from 147 to 32%. Goodness of fit and discriminatory performance (AUC = 0.83) were good. Female gender, however, could not be identified as an independent risk factor for adverse outcome (OR 1.6; 95% CI 0.8-3.4). Risk-adjusted mortality was calculated as 4.9% in females and 2.6% in males. Low body surface area (<1.66 m(2)) was associated with excess mortality in females.
Conclusions:
Gender-related disparity in outcome still remains present after surgery with minimized extracorporeal circulation. However, female gender per se is not an independent risk factor for in-hospital mortality, but close attention should be paid on modifiable risk factors.