Female Gender Does Not Increase Perioperative Risk in Coronary Bypass Surgery

Gulbins, H; Ennker, I. C.; Malkoc, Aldin; Ennker, J.

doi:10.1055/s-0030-1249924

Cited by 11 publications

(10 citation statements)

References 12 publications

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“…The example in Fig 1 shows that risk score calculation substantially overestimates true risk, an error that is corrected if the factor “female sex” is excluded from calculation. This finding is supported by several other studies that also found that female sex is not associated with increased mortality [ 6 , 14 , 26 ]. Some studies even suggested a protective effect of female sex on long term survival after CABG [ 1 , 27 ].…”

Section: Discussionsupporting

confidence: 88%

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Female sex is not a risk factor for post procedural mortality in coronary bypass surgery in the elderly: A secondary analysis of the GOPCABE trial

et al. 2017

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ObjectiveFemale sex is considered a significant risk in cardiac surgery and is included in the majority of scores for risk assessment. However, the evidence is controversial and older women undergoing cardiac surgery have not specifically been investigated. We assessed the influence of female sex on surgical risk (30-day mortality) in a secondary analysis of the GOP-CABE trial (German Off-Pump Coronary Artery Bypass grafting in the Elderly (GOPCABE) trial, comparing on-to off-pump) and also evaluated its impact on risk prediction from commonly used risk scores. MethodsWe performed logistic regression analyses on the GOPCABE trial population, where patients were randomized to either on-or off-pump CABG. The study was performed in 12 cardiac surgery centers in Germany and analyzed 2394 patients having undergone CABG at age !75 years (1187 on-pump, 1207 off-pump). Of the 2394 patients, 755 (32%) were women. The logistic EuroSCORE and the German KCH score were calculated as expected (E) mortality and values were compared to observed (O) 30-day mortality (O/E ratio). ResultsThere was no difference in mortality or major cardiovascular adverse events after 30 days between men and women for both on-and off-pump CABG (men: on-vs. off-pump OR = 0.90, 95%-CI: [0.63;1.27]; women: on-vs. off-pump OR = 1.07, 95%-CI: [0.62;1.87]). Therefore, groups were combined for further analyses. Both men and women had considerable and similar comorbidities. Expected mortality was significantly higher for women than for PLOS ONE | https://doi

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Section: Discussionsupporting

confidence: 88%

“…Thus, our results and those of others [ 1 , 6 , 14 , 26 , 27 ] suggest that the impact of female sex as a risk factor in coronary artery bypass surgery should be re-evaluated and current risk scores should be readjusted specifically for this older patient population.…”

Section: Discussionsupporting

confidence: 59%

Female sex is not a risk factor for post procedural mortality in coronary bypass surgery in the elderly: A secondary analysis of the GOPCABE trial

et al. 2017

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“…Thus, our data are in line with several reports published recently [14,15]. On the other hand, several studies using STS database data from up to almost 345,000 participants identified female gender as an independent risk factor despite adjusting for risk profile [6,16].…”

Section: Discussionsupporting

confidence: 93%

Gender’s impact on outcome in coronary surgery with minimized extracorporeal circulation

et al. 2012

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“…In very high-risk patients, female and male mortality rates after CABG were found to be similar, whereas female gender was otherwise an independent predictor of higher operative CABG mortality [ 5 ]. In other studies, no gender-specific differences for perioperative mortality [ 11 ] and for long-term survival after CABG were observed [ 1 , 12 – 14 ]. Older age, previous CABG, previous MI and diabetes were independent risk factors for higher mortality, but female gender was not [ 15 ].…”

Section: Introductionmentioning

confidence: 92%

Female Gender and Differences in Outcome after Isolated Coronary Artery Bypass Graft Surgery: Does Age Play a Role?

et al. 2016

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IntroductionFemale gender is a known risk factor for early and late mortality after coronary artery bypass graft surgery (CABG). Higher age of women at operation may influence outcome, since age per se is also an important risk factor. The purpose of our study was to analyze possible gender differences in outcome after isolated CABG in different age groups to delineate the impact of female gender and age.MethodsAll patients over 60 years of age undergoing isolated CABG at our department during 2001 and 2011 were included and categorized by age into sexagenarians (2266, 16.6% women), septuagenarians (2332, 25.4% women) and octogenarians (374, 32% women) and assessed by gender for 30-day and 180-day mortality.ResultsThirty-day mortality was significantly higher in women only amongst septuagenarians (7.1 vs. 4.7%, p = 0.033). Same differences apply for 180-day mortality (12.3 vs. 8.2%, p = 0.033) and estimated one-year survival (81.6 ± 4.2 vs. 86.9 ± 2.2%, p = 0.001). Predictive factors for 30-day mortality of septuagenarian were logistic EuroSCORE (ES) (p = 0.003), perioperative myocardial infarction (MI) (p<0.001), pneumonia (p<0.001), abnormal LV-function (p<0.04) and use of LIMA graft (p<0.001), but not female gender. However, female gender was found to be an independent predictor for 180-day mortality (HR 1.632, p = 0.001) in addition to ES, use of LIMA graft, perioperative MI, pneumonia and abnormal LV function (HR 1.013, p = 0.004; HR 0.523, p<0.001; HR 2.710, p<0.001; HR 3.238, p<0.001; HR 2.013, p<0.001).ConclusionWomen have a higher observed probability of early death after CABG in septuagenarians. However, female gender was not found to be an independent risk factor for 30-day, but for 180-day survival. Therefore, reduction of high impact risk factors such as perioperative MI and enhancement of LIMA use should be future goals. In view of our findings, decision for surgical revascularization should not be based on gender.

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Female Gender Does Not Increase Perioperative Risk in Coronary Bypass Surgery

Cited by 11 publications

References 12 publications

Female sex is not a risk factor for post procedural mortality in coronary bypass surgery in the elderly: A secondary analysis of the GOPCABE trial

Female sex is not a risk factor for post procedural mortality in coronary bypass surgery in the elderly: A secondary analysis of the GOPCABE trial

Gender’s impact on outcome in coronary surgery with minimized extracorporeal circulation

Female Gender and Differences in Outcome after Isolated Coronary Artery Bypass Graft Surgery: Does Age Play a Role?

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