Women less likely to survive heart surgery complications than men
Women are more likely to die from complications following cardiovascular surgery than men, according to a new analysis published in JAMA Surgery.[1]
The study’s authors explored data from more than 860,000 Medicare beneficiaries who underwent a high-risk cardiac or vascular surgery from October 2015 to February 2020. Surgeries included abdominal aortic aneurysm repair, coronary artery bypass grafting, surgical aortic valve replacement and mitral valve replacement/repair.
Overall, 35.2% of patients included in the study were women. The mean ages were 74.8 years old for those female patients and 73.4 years old for the study’s male patients. In addition, female patients were less likely to have an unplanned surgery, but more likely to present with two or more comorbidities.
For the sake of this analysis, serious complications were defined as any postoperative complication that resulted in an extended length of stay. Examples of such complications include myocardial infarction, pulmonary embolism, pulmonary failure, pneumonia, surgical site infections and more.
The group found that the serious complication rates were nearly identical for male and female patients—14.98% vs. 14.37%, respectively. However, 30-day mortality was 4.22% for female patients and 3.34% for male patients. In addition, failure to rescue rates were 10.71% for female patients and 8.58% for male patients, and reoperation was slightly more common among male patients.
“This is an issue for the entire United States healthcare system: we are failing to rescue women after high-risk surgery even though the rate of postoperative complication is similar to men,” first author Catherine M. Wagner, MD, MSc, an integrated thoracic surgery resident at University of Michigan Health (U-M Health), said in a prepared statement. “There needs to be improved recognition and response to these complications if we are to narrow the sex disparities after high risk surgery.”
“These high risk procedures are inherently expected to have higher complication rates, but patients are still expected to have a positive outcome if the complication is managed quickly,” added co-author Gorav Ailawadi, MD, MBA, chair of cardiac surgery at U-M Health and a director of the University of Michigan Health Frankel Cardiovascular Center. “In our study, female patients had a lower rate of reoperation than males. This may not be due to a lower need for reoperation, it could instead be a signal that their complications were not appropriately addressed.”
The authors wrote that it is important for all healthcare providers to be aware of “implicit biases.” Specific training may be required. The group also emphasized that continuing to examine outcomes by sex “can help address the longstanding neglect of women’s health in research, uncover disparities and identify underlying mechanisms that, if addressed, can improve outcomes for all patients.”
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