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

Abstract

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 < .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 < .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.

A Call to Action to Improve Outcomes in Women Undergoing Surgical Coronary Revascularization

“…Consistent with this, Gaudino et al noted that women have significantly more of the preoperative variables that significantly affect mortality (prior myocardial infarction, diabetes, peripheral vascular disease, cerebrovascular disease, preoperative intra-aortic balloon pump, and urgent surgery). Figure 1 demonstrates an alarming visual difference in outcomes between women and men over time. Remarkably, women had significantly higher operative mortality (and operative mortality and morbidity) every single year of the study.…”

“…It is well known that women are sicker and older than men when they present for CABG and that they have higher mortality following surgery . Consistent with this, Gaudino et al noted that women have significantly more of the preoperative variables that significantly affect mortality (prior myocardial infarction, diabetes, peripheral vascular disease, cerebrovascular disease, preoperative intra-aortic balloon pump, and urgent surgery). Figure 1 demonstrates an alarming visual difference in outcomes between women and men over time.…”

“…We congratulate Gaudino and colleagues for again capturing the persistently higher mortality and morbidity after isolated coronary artery bypass grafting (CABG) in women compared with men in the US. They included 1 297 204 patients who underwent primary isolated CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database to compare outcomes between men (979 488 [75.5%]) and women (317 716 [24.5%]).…”

“…Women must be treated with guideline-directed optimal medical and surgical care. Gaudino et al remind us that studies directly comparing CABG with PCI in women are lacking; thus, it is imperative that both sexes must be evaluated in basic science research and women must be enrolled in clinical trials. Additionally, surgeon specialization in coronary surgery and the establishment of center specialization for women should be considered …”

Assessment of Selected Immune Parameters in Patients Undergoing Cardiac Surgery with the Use of Cardiopulmonary Bypass: Aspects of Age and Sex—A Pilot Study

“…The use of CPB may promote the release of pro- and anti-inflammatory mediators into the blood and, more importantly, disturb their balance [ 11 , 12 , 13 ]. The increased release of cytokines may affect the functions of the respiratory system and the kidneys, or lead to myocardial damage or neurological disorders [ 14 , 15 ].…”