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Age-dependent sex effects on outcomes after pediatric cardiac surgery
Lazaros K Kochilas1, Jeffrey M Vinocur, Jeremiah S Menk
1Pediatric Heart Center, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN.
Insights
Sex impacts pediatric cardiac surgery outcomes. Girls under six months undergoing high-risk operations face higher mortality, suggesting a biological sex effect on cardiovascular stress.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Medical Outcomes Research
Background:
- Differential cardiovascular disease outcomes are noted between sexes in adults.
- Potential sex-based disparities in outcomes following pediatric cardiac surgery warrant investigation.
Purpose of the Study:
- To evaluate the influence of patient sex on mortality after pediatric cardiac operations.
- To explore interactions between sex and factors like age, risk category, and surgical complexity on mortality.
Main Methods:
- Retrospective analysis of data from the Pediatric Cardiac Care Consortium (1982-2007).
- Logistic regression was used to assess the effect of sex on 30-day in-hospital mortality in patients under 18.
- Analysis considered interactions with age, risk category, weight z-score, and surgical year.
Main Results:
- The study included 76,312 pediatric cardiac operations; 55% were in boys.
- Unadjusted mortality rates were similar (5.2% for boys, 5.0% for girls).
- Adjusted analysis revealed a significant association between sex and postsurgical mortality (P=0.002). A notable age-dependent effect showed increased mortality in girls during the first six months after high-risk operations.
Conclusions:
- Patient sex significantly affects mortality after pediatric cardiac surgery.
- Girls undergoing high-risk cardiac operations in early infancy demonstrate an elevated risk of death.
- The observed age-dependent relationship suggests a biologically-based sex effect on postoperative cardiovascular stress.
Background:
Sex has been linked to differential outcomes for cardiovascular disease in adults. We examined potential sex differences in outcomes after pediatric cardiac surgery.
Methods And Results:
We retrospectively analyzed data from the Pediatric Cardiac Care Consortium (1982-2007) by using logistic regression to evaluate the effects of sex on 30-day within-hospital mortality after pediatric (<18 years old) cardiac operations and its interaction with age, risk category, z-score for weight, and surgical year for the whole cohort. Of 76 312 operations, 55% were in boys. Unadjusted mortality was similar for boys and girls (5.2% versus 5.0%, P=0.313), but boys were more likely to have cardiac surgery as a neonate and to have more complex operations. After adjustment, the overall test of any association between postsurgical mortality and sex was significant (P=0.002), but the overall test of any interaction was not (P=0.503). However, a potential age-dependent sex effect on postsurgical mortality was observed among infants subjected to high-risk operations, with girls doing worse during the first 6 months of life.
Conclusions:
Patient sex has a significant effect on mortality after pediatric cardiac operations, with an increased risk of death in early infancy for girls after high-risk cardiac operations. This age-dependent relationship supports a sex-related biological effect on postoperative cardiovascular stress.
