Sex Differences in Preoperative Risk Profiles and 1-Year Mortality Following Elective Cardiac Surgery: A...

Area of Science:

• Cardiology
• Cardiac Surgery
• Health Outcomes Research

Background:

• Females generally face higher mortality rates post-cardiac surgery compared to males.
• Underlying factors contributing to this sex disparity in outcomes are not fully understood.
• This study investigates sex-specific preoperative risk profiles associated with one-year mortality after elective cardiac surgery.

Purpose of the Study:

• To compare preoperative risk characteristics of deceased versus surviving patients after elective cardiac surgery.
• To identify sex-specific risk profiles linked to one-year postoperative mortality.
• To inform the development of tailored perioperative management strategies.

Main Methods:

• Retrospective cohort study utilizing data from Amsterdam University Medical Centres (2001-2020).
• Inclusion of adult patients undergoing elective cardiac surgery.
• Descriptive and comparative analyses of preoperative differences between survivors and non-survivors, stratified by sex.

Main Results:

• The cohort included 10,614 patients (26% female). One-year mortality was 5.1% for females and 3.8% for males.
• Female non-survivors showed higher rates of moderately impaired left ventricular function, pulmonary hypertension, extracardiac arteriopathy, and kidney dysfunction.
• Male non-survivors had higher age, lower Body Surface Area, severely impaired left ventricular function, history of myocardial infarction, and underwent specific surgical procedures (aortic or combined valve + CABG).

Conclusions:

• One-year mortality following elective cardiac surgery is associated with distinct preoperative risk profiles in females and males.
• Female mortality is linked to systemic disease, while male mortality is associated with direct cardiac damage.
• Recognizing these sex-specific profiles is essential for developing equitable and precise perioperative care.