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Published on: March 27, 2018
Sex Differences in Failure-to-Rescue After Coronary Artery Bypass Grafting
William W Qu1, Jane W Wei2, Jose N Binongo1
1Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Insights
Women undergoing coronary artery bypass grafting (CABG) face higher morbidity and mortality but have similar failure-to-rescue (FTR) rates compared to men. Focus on pre- and intraoperative care to improve outcomes.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Quality Improvement
Background:
- Female patients often experience poorer outcomes following coronary artery bypass grafting (CABG).
- Failure-to-rescue (FTR) is a critical indicator of healthcare system quality.
- This study examined FTR rates in women undergoing CABG.
Purpose of the Study:
- To determine if women undergoing CABG exhibit higher rates of failure-to-rescue (FTR).
- To compare FTR between female and male patients after isolated, nonemergent CABG.
Main Methods:
- Retrospective review of 20,045 patients undergoing isolated, nonemergent CABG.
- Propensity score matching was used to create comparable groups of male and female patients.
- FTR defined as 30-day postoperative death following stroke, renal failure, reoperation, or prolonged ventilation.
Main Results:
- 4980 matched pairs were analyzed.
- Women had higher rates of stroke, prolonged ventilation, and 30-day mortality.
- No statistically significant differences in FTR rates were found between sexes for any specific complication.
Conclusions:
- Despite higher morbidity and mortality, women had similar FTR rates to men after CABG.
- Improving CABG outcomes for women may require focusing on preoperative and intraoperative care, not solely postoperative management.
Background:
Female patients experience worse outcomes after coronary artery bypass grafting (CABG). We investigated whether rates of failure-to-rescue (FTR), a systems-based quality indicator, were greater in women who underwent CABG.
Methods:
A retrospective review was conducted on 20 045 patients who underwent isolated, nonemergent CABG between January 2002 and August 2019 at a single academic center. FTR was defined as postoperative death within 30 days after stroke, renal failure, reoperation, and prolonged ventilation. Propensity score matching was performed utilizing preoperative variables, excluding sex.
Results:
A total of 4980 propensity score-matched pairs were identified. In the matched analysis, women experienced higher rates of postoperative stroke (1.9% vs 1.2%; P = .008), prolonged ventilation (13.3% vs 10.0%, P < .001), and 30-day mortality (2.6% vs 1.8%; P = .01). Rates of FTR after stroke (P = .36), renal failure (P = .11), reoperation (P = .86), and prolonged ventilation (P = .48) were not statistically significant between female and male patients.
Conclusions:
Women who underwent isolated, nonemergent CABG had statistically similar frequencies of FTR compared with their male counterparts despite experiencing greater rates of morbidity and mortality. Further efforts to narrow the sex outcome gap after CABG should focus on preoperative and intraoperative phases of care instead of postoperative management.
