Other Authors:
Lauren Kari Dixon:
lauren.dixon@bristol.ac.uk
Arnaldo Dimagli:
arnaldo.dimagli@bristol.ac.uk
Ettorino Di Tommaso: fq18031@bristol.ac.uk
Shubhra Sinha: shubhra.sinha@doctors.org.uk
Daniel Paul Fudulu: daniel.fudulu@bristol.ac.uk
Manraj Sandhu: manraj.s.sandhu@gmail.com
Umberto Benedetto: umberto.benedetto@bristol.ac.uk
Word Count:
Abstract
Objectives : Female sex is considered a risk factor for mortality
and morbidity following cardiac surgery. This study is the first to
review the UK adult cardiac surgery national database to compare
outcomes following surgical coronary revascularisation and valvular
procedures between females and 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 mixed-effect logistical/linear
regression models were used to assess relationships between sex and
outcomes, adjusting for baseline characteristics.
Results: Females, compared to males, had greater odds of
experiencing 30-day mortality (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 had higher rates
of 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
longer length of hospital 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).
Conclusion: 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 implementation of strategies to improve outcomes
in females.
Key Words: Sex. Gender. Cardiac Surgery. CABG. AVR. MVR.
Mortality. Disparities