(Source: https://www.news-medical.net/news)
Compared with men, women continue to have a roughly 30-40 percent
higher risk of dying following coronary artery bypass surgery, according to a
large study led by investigators at Weill Cornell Medicine and
NewYork-Presbyterian/Weill Cornell Medical Center. The analysis showed that, without
adjusting for differences in age and other health factors that influence risk,
the female bypass patients had a 2.8 percent rate of death during or soon after
surgery, compared with 1.7 percent for male patients, a nearly 50 percent
difference that only dropped 10-20 percent after accounting for these factors.
The study, which appears Mar. 1 in JAMA Surgery, was based on data from nearly 1.3
million bypass surgeries performed in the United States from 2011 to 2020. It
confirms the findings of studies based on surgery data from prior decades.
Doctors perform about 370,000 coronary artery bypass graft surgeries in
the U.S. every year. Over the past few decades, advances in surgical techniques
and overall care have brought improved outcomes from these surgeries.
However, since the 1990s, studies of these surgeries have been finding
evidence that, compared with male patients, female patients tend to have worse
outcomes. Female bypass surgery patients on average are older and more likely
to have chronic diseases such as diabetes and hypertension. But even when
researchers adjust their analyses to take these factors into account, women
still appear to have worse outcomes on average.
One of the big questions for the field has been whether these sex
differences in outcomes, first observed more than 30 years ago, have continued
in recent years as surgical techniques and surrounding care have improved. To
answer this question, Dr. Gaudino and colleagues-;including surgeons in the
U.S., Canada, and Austria-;analyzed bypass surgery cases from 2011-2020 in the
Adult Cardiac Surgery Database, which is maintained by the Chicago-based
Society for Thoracic Surgeons. The database covers a large proportion of U.S.
bypass surgeries, and also includes data from medical centers abroad.
The analysis included a total of 1,297,204 bypass surgeries, of which
317,716 were in women. The main outcome measures were "operative
mortality"-;death during surgery or within the 30 days following
surgery-;and a composite measure defined as operative mortality or a major
post-operative complication, such as stroke or kidney failure.
Without adjusting for differences in age and other health factors that
influence risk, the investigators found that female bypass patients had a 2.8
percent rate of death during or soon after surgery, compared with 1.7 percent
for male patients; and a 22.9 percent rate of the composite measure compared
with 16.7 percent for male patients. Even after adjustment for male/female
differences in those risk factors, being female appeared to bring a
significantly higher risk of death or major complications. For mortality, being
female was associated with a 28 percent to 41 percent higher risk depending on
the year of surgery during the covered period. For the combined outcome measure,
being female was associated with a 2 percent to 9 percent higher risk. There
was no significant trend for either measure during the analyzed period.
The findings underscore the importance of determining why women have
worse outcomes for this relatively common surgery, said Dr. Gaudino, who is
also director of the Joint Clinical Trials Office at Weill Cornell Medicine and
NewYork-Presbyterian.
"We're clearly missing something here, and that means we need more
data on women-;data on the physiology of their coronary artery disease and how
it tends to differ from men's, and data on their responses to different
treatments and surgical techniques," he said.
To that end, he and his colleagues are planning a clinical trial
exclusively in female patients, to see if the use of multiple coronary artery
bypasses during surgery improves outcomes over single-artery bypasses.
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