Coronary surgery in women: How can we improve outcomes

Zwischenberger, Brittany A.; Jawitz, Oliver K.; Lawton, Jennifer S.

doi:10.1016/j.xjtc.2021.09.051

Cited by 8 publications

(13 citation statements)

References 58 publications

(116 reference statements)

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“…Reducing mortality in women after CABG likely entails a multifactorial approach. 25 The indication to revascularization may have to be different in women compared with men due to the differences in the processes and pathology of coronary artery disease. current diagnostic and therapeutic protocols for coronary revascularization are all informed from data derived from studies performed prevalently in men 21 and may be inadequate for women.…”

Section: Discussionmentioning

confidence: 99%

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Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

et al. 2023

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ImportanceIt has been reported that women undergoing coronary artery bypass have higher mortality and morbidity compared with men but it is unclear if the difference has decreased over the last decade.ObjectiveTo evaluate trends in outcomes of women undergoing coronary artery bypass in the US from 2011 to 2020.Design, Setting, and ParticipantsThis retrospective cohort study at hospitals contributing to the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons included 1 297 204 patients who underwent primary isolated coronary artery bypass from 2011 to 2020.ExposureCoronary artery bypass.Main Outcomes and MeasuresThe primary outcome was operative mortality. The secondary outcome was the composite of operative mortality and morbidity (including operative mortality, stroke, kidney failure, reoperation, deep sternal wound infection, prolonged mechanical ventilation, and prolonged hospital stay). The attributable risk (the association of female sex with coronary artery bypass grafting outcomes) for the primary and secondary outcomes was calculated.ResultsBetween 2011 and 2020, 1 297 204 patients underwent primary isolated coronary artery bypass grafting with a mean age of 66.0 years, 317 716 of which were women (24.5%). Women had a higher unadjusted operative mortality (2.8%; 95% CI, 2.8-2.9 vs 1.7%; 95% CI, 1.7-1.7; P &lt; .001) and overall unadjusted incidence of the composite of operative mortality and morbidity compared with men (22.9%; 95% CI, 22.7-23.0 vs 16.7%; 95% CI, 16.6-16.8; P &lt; .001). The attributable risk of female sex for operative mortality varied from 1.28 in 2011 to 1.41 in 2020, with no significant change over the study period (P for trend = 0.38). The attributable risk for the composite of operative mortality and morbidity was 1.08 in both 2011 and 2020 with no significant change over the study period (P for trend = 0.71).Conclusions and RelevanceWomen remain at significantly higher risk for adverse outcomes following coronary artery bypass grafting and no significant improvement has been seen over the course of the last decade. Further investigation into the determinants of operative outcomes in women is urgently needed.

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Section: Discussionmentioning

confidence: 99%

“…Reducing mortality in women after CABG likely entails a multifactorial approach . The indication to revascularization may have to be different in women compared with men due to the differences in the processes and pathology of coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

et al. 2023

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“…Focusing in on ischemic coronary artery disease, women traditionally have had lower rates of coronary artery bypass graft (CABG) surgery compared with men [7 ▪ ]. Mahowald et al showed a higher in-hospital mortality in women undergoing CABG following a myocardial infarction when compared to men even when they were propensity matched [8].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular disease, surgery and outcomes in women: are they any different

Klein¹

2022

Current Opinion in Anaesthesiology

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Purpose of reviewCardiovascular disease is a leading cause of death for women worldwide and continues to be a major determinant of significant morbidity. Several studies have investigated the marked differences in diagnosis, treatment and etiology in cardiovascular disease and how it relates to gender. In this review, several key studies highlight the stark differences and bring light to the disparity and potential opportunities for further research. Recent findingsOne noted area of gender disparity is ischemic cardiac disease as it relates to surgical management. Women have historically had delays in diagnosis, inferior surgical revascularization techniques, and inadequate postoperative care when compared to men. SummaryBy highlighting the disparities in cardiovascular ischemic care, the hope is to bring attention and future research to a population group that is currently undertreated for their ischemic disease and suffering high mortality rates.

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“…Females have unique CVD risk factors, including gestational diabetes, premature births, autoimmune diseases, and treatment for breast cancer. Though diabetes and depression also affect males, they might be greater risk factors in females than in males [1][2][3]. The earliest data available were based on randomized controlled trials that assessed results only in males [4][5].…”

Section: Introductionmentioning

confidence: 99%

Effect of Gender on Postoperative Outcome and Duration of Ventilation After Coronary Artery Bypass Grafting (CABG)

Alamri¹,

Alotaibi²,

Alghatani³

et al. 2023

Cureus

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Introduction: The study assessed coronary artery bypass grafting (CABG) postoperative outcomes and associated factors in Saudi male and female patients. This was a retrospective cohort of patients who underwent CABG at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, from January 2015 to December 2022.Results: We included 392 patients, of whom 63 (16.1%) were female. Female undergoing CABG were significantly older (p=0.0001), had a significantly higher incidence of diabetes (p=0.0001), obesity (p=0.001), hypertension (p=0.001), and congestive heart failure (p=0.005), with a smaller body surface area (BSA) (p=0.0001) than male. Though renal dysfunction, previous cerebrovascular accident/transient ischemic attack (CVA/TIA), and myocardial infarction (MI), incidences were similar in both genders. Females were at significantly higher risk of mortality (p=0.0001), longer hospital stay (p=0.0001), and prolonged ventilation (p=0.0001). Preoperative renal dysfunction was the only statistically significant predictor of postoperative complications (p=0.0001). Female gender and preoperative renal dysfunction, were significant independent predictors of postoperative mortality and prolonged ventilation (p=0.005).Conclusion: This study's findings indicated that females have worse CABG outcomes and a higher risk of morbidities and complications. Uniquely our study showed a higher incidence of prolonged ventilation in females postoperatively.

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Coronary surgery in women: How can we improve outcomes

Cited by 8 publications

References 58 publications

Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

Cardiovascular disease, surgery and outcomes in women: are they any different

Effect of Gender on Postoperative Outcome and Duration of Ventilation After Coronary Artery Bypass Grafting (CABG)

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