Females Do Not Have Increased Adverse Events After Combined Carotid Endarterectomy and Cardiac Operations Despite Greater Abundance of Symptomatic Carotid Disease in This Female Cohort

Abstract

Despite numerous reports of female patients having more adverse events after vascular procedures, the impact of birth sex on adverse outcomes following combined carotid endarterectomy (CEA) and cardiac operations has not been reported. The objective of this project was to define the event rate using an institutional data warehouse. We hypothesized that women undergoing combined carotid and cardiac operations would be more likely than men to have postoperative adverse events. We identified patients by Current Procedural Terminology codes and performed a retrospective cohort study of patients who underwent CEA and cardiac operations (coronary artery bypass grafting with or without valve or isolated valve operations) in a simultaneous or staged fashion between 2007 and 2020. Patient comorbidities, operative indications, symptomatic status, and postoperative outcomes were abstracted via chart review. Late deaths, defined as deaths that occurred after initial 30-day postoperative period, were obtained from the National Death Index. The primary exposure variable was male or female birth sex. Fisher’s exact test with a P value of less .05 used to test for significance. We identified 134 patients (40.3% female) who underwent combined CEA + cardiac operations. Most (105) of the cardiac operations (105) were coronary artery bypass grafts, 16 were coronary artery bypass grafts + valve, and 13 were valve operations. Women were more likely to present with symptomatic carotid disease (women 19% vs men 6%; P < .05) (Table). The mean time between staged carotid and cardiac operations was 3.8 ± 3.3 days. There was one myocardial infarction (MI) in a male patient after CEA in the staged cohort and one MI in a female patient after synchronous group. There were two postprocedural strokes in male patients, both after staged cardiac operation and neither involved the CEA distribution. There were five perioperative deaths related to the cardiac operation. There were 14 late deaths with an average time to late death of 1272 ± 721 and 1248 ± 1219 days for women and men, respectively, after the CEA (Table). In our institutional database, women comprised 40% of patients undergoing combined carotid and cardiac operations. We found that women were more likely to have symptomatic carotid disease, but they did not have a greater risk of MI, stroke, or death (perioperative or late) compared with men. There were few adverse events suggesting that CEA is safe in women and men undergoing cardiac operations. We conclude that female sex does not increase the risk of adverse events in this challenging cohort of vascular patients.TablePatient comorbidities, operative indications, and outcome metricsFemaleΜaleP value(n = 54)(n = 80)Comorbidities Age (average)66.1 ± 8.668.2 ± 7.9- Diabetes26 (48%)39 (49%)1 Average A1c7.1 ± 1.87.5 ± 1.9- Hypertension47 (87%)73 (91%).57 Hyperlipidemia41 (76%)59 (74%)1 Renal dysfunction8 (15%)23 (29%).09 Average body mass index33.0 ± 8.230.3 ± 7.1- Tobacco exposure31 (57%)54 (68%).32Operative indications Symptomatic carotid10 (19%)5 (6%).048a Symptomatic heart28 (52%)35 (44%).382 Symptomatic for both3 (6%)1 (1%).302 Staged operation32 (59%)42 (53%).482 Synchronous operations22 (41%)38 (48%).482Outcomes MI1 (2%)1 (1%)1 Stroke0 (0%)2 (3%).515 Postoperative death2 (4%)3 (4%)1 Late deatha6 (11%)8 (10%)1MI, Myocardial infarction.Data are presented as percentage (x/n) or mean ± standard deviation.aP < .05.bDeaths captured via data warehouse query of the National Death Index. Open table in a new tab