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Published on: March 27, 2018
Sex Differences in Outcomes After Coronary Artery Bypass Grafting
Soham Gupta1, Briana Lui1, Xiaoyue Ma2
1Department of Anesthesiology, Weill Cornell Medicine, Center for Perioperative Outcomes, New York, NY.
Insights
Women undergoing coronary artery bypass grafting (CABG) face higher inpatient mortality and readmission risks compared to men. This persistent sex-based disparity in CABG outcomes requires further investigation and targeted interventions.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Sex Differences in Medicine
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Previous studies have suggested potential sex differences in outcomes following CABG, but comprehensive, population-based analyses are needed.
- Understanding these disparities is crucial for improving patient care and outcomes.
Purpose of the Study:
- To investigate sex-based differences in inpatient mortality rates after CABG.
- To examine sex-based differences in 30-day and 90-day readmission rates following CABG.
- To analyze these outcomes in a large, multistate patient population.
Main Methods:
- Retrospective analysis of patient hospitalization and discharge records.
- Utilized data from the State Inpatient Databases (SID) of the Healthcare Cost and Utilization Project (HCUP).
- Included over 300,000 patients undergoing CABG across five states from 2007 to 2014, employing bivariate and multivariate logistic regression analyses.
Main Results:
- Female patients experienced a higher in-hospital mortality rate (2.65%) compared to male patients (1.60%).
- Women were 32% more likely to die post-CABG than men, even after adjusting for multiple confounding factors.
- Significantly higher adjusted odds of 30-day (aOR: 1.24) and 90-day (aOR: 1.25) readmissions were observed in women compared to men.
Conclusions:
- Female patients undergoing CABG face a demonstrably greater risk of in-hospital death and subsequent readmissions.
- This persistent sex-based disparity in CABG outcomes has been noted for decades and warrants continued attention.
- The findings underscore the need for sex-specific strategies to mitigate adverse outcomes in female CABG patients.
Objective:
To examine sex differences in inpatient mortality and 30-day and 90-day readmissions after coronary artery bypass grafting (CABG) among a multistate population.
Design:
A retrospective analysis of patient hospitalization and discharge records.
Setting:
All-payer patients in nonpsychiatric hospitals in New York, Maryland, Florida, Kentucky, and California.
Participants:
A total of 304,080 patients from the State Inpatient Databases Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality from January 2007 to December 2014 who underwent CABG surgery.
Interventions:
Bivariate analysis and multivariate logistic regression were performed to obtain unadjusted rates and adjusted odds ratios, respectively, for in-hospital mortality and readmissions by sex.
Measurements And Main Results:
Of the patients who underwent CABG, 5,699 patients (1.87%) died, including 2,131 women (2.65%) and 3,568 men (1.60%). The authors found that women were 32% more likely to die compared with men (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.25-1.40) after adjusting for age, race, insurance status, median income, Elixhauser comorbidity index measures, year of procedure, state, and hospital surgical volume. Women, compared with men, also had significantly increased adjusted odds of 30-day and 90-day readmissions (30-day aOR: 1.24, 95% CI: 1.21-1.28; 90-day aOR: 1.25, 95% CI: 1.22-1.28).
Conclusion:
This study demonstrated that female patients who undergo CABG are at a greater risk of in-hospital death and 30-day and 90-day readmission compared with men. This sex-based disparity in outcomes has persisted since identification some 40 years ago.
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