Article Text
Abstract
Objective The outcome of female patients after adult cardiac surgery has been reported to be less favourable compared with the outcome of male patients. This study compares men with women with respect to patient and procedural characteristics and early mortality in a contemporary national cohort of patients who underwent aortic valve (AV) and combined aortic valve/coronary (CABG/AV) surgery.
Methods All patients who underwent AV (n=8717, 56% male) or a combined CABG/AV surgery (n=5867, 67% male) in the Netherlands between January 2007 and December 2011 were included.
Results In both groups, women were generally older than men (p<0.001) and presented with higher logistic EuroSCORES. In isolated AV surgery, men and women had comparable in-hospital mortality (OR 1.20, 95% CI 0.90 to 1.61; p=0.220). In concomitant CABG/AV surgery, in-hospital mortality was higher in women compared with men (OR 2.00, 95% CI 1.44 to 2.79; p<0.001). The area under the curve for logistic EuroSCORE 1 was systematically higher for men versus women in isolated AV surgery 0.82 (95% CI 0.78 to 0.86) vs 0.75 (95% CI 0.69 to 0.80) and in concomitant CABG/AV surgery 0.78 (95% CI 0.73 to 0.82) vs 0.69 (95% CI 0.63 to 0.74). Finally, (the weight of) risk factors associated with in-hospital mortality differed between men and women.
Conclusions There are substantial male-female differences in patient presentation and procedural aspects in isolated AV and concomitant CABG/AV surgery in the Netherlands. Further studies are necessary to explore the mechanisms underlying the observed differences. In addition, the observation that standard risk scores perform worse in women warrants exploration of male-female specific risk models for patients undergoing cardiac surgery.Brief title:
- carotid disease
- valvular heart disease
- quality and outcomes of care
- valve disease surgery
- cardiac risk factors and prevention.
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Footnotes
Contributors MMM and JJMT were involved in the conception of the work. MMM was involved in data collection. MMM, SST and JJMT were involved in data analysis and interpretation. MMM and SST were involved in drafting the article. All authors were involved in critical revision of the article as well as in final approval of the version to be published.
Funding This work was supported by a NWO Veni grant of the Netherlands Organisation for Scientific Research [NWO grant number 916.160.87] to [MM].
Competing interests This research was conducted on behalf of the data registry committee of the Netherlands
Association for Cardio-Thoracic Surgery.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.