Abstract
Introduction: Female sex is considered an independent risk factor for mortality and morbidity following cardiac surgery. This study is the first to review the UK national database to compare outcomes following surgical revascularisation and valvular cardiac procedures between females and males. Hypothesis: Females have worse outcomes following cardiac surgery than males. Methods: Using data from National Adult Cardiac Surgery Audit (NACSA), we identified all elective and urgent, isolated coronary artery by-pass grafting (CABG), aortic valve replacement (AVR) and mitral valve replacement/repair (MVR) procedures from 2010-2018. We compared baseline data, operative data and outcomes of mortality, stroke, renal failure, deep sternal wound infection, return to theatre for bleeding and length of hospital stay. Multivariable logistical/linear regression models were used to assess relationships between sex and our outcomes, adjusting for baseline characteristics. Results: Females, compared to males, had a greater odds of experiencing 30-day mortality in each procedure (CABG OR 1.76, CI 1.47-2.09, p<0.001; AVR OR 1.59, CI 1.27-1.99, p<0.001; MVR OR 1.37, CI 1.09-1.71, p=0.006). After CABG, females also experienced increased need for post-operative dialysis (OR 1.31, CI 1.12-1.52, p<0.001), deep sternal wound infections (OR 1.43, CI 1.11-1.83, p=0.005) and length of stay (Beta 1.2, CI 1.0-1.4, p<0.001) compared to males. Female sex was protective against returning to theatre for post-operative bleeding following CABG (OR 0.76, CI 0.65-0.87, p<0.001) and AVR (OR 0.72, CI 0.61-0.84, p<0.001). Conclusions: Despite advances in cardiac surgery, females in the UK have an increased risk of short-term mortality after cardiac surgery compared to males. This highlights the need to focus on the understanding of the causes behind these disparities and therefore implementation of strategies to improve this.
Published Version
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