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

Ried, Michael; Lunz, Dirk; Kobuch, Reinhard; Rupprecht, Leopold; Keyser, Andreas; Hilker, Michael; Schmid, Çhristof; Diez, Claudius

doi:10.1007/s00392-011-0410-4

Cited by 15 publications

(13 citation statements)

References 24 publications

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“…Those with a p-value <0.1 at Pearson's correlation chi-square, as well as age and sex, were added in the multivariate model. Since previous studies demonstrated that body surface area (BSA) is associated with a worse outcome post-CABG in female sex we used BSA instead of body mass index [13,14]. Because of the welldocumented surgical characteristics, a subanalysis was made regarding the type of grafts used during CABG.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, our results showed no differences in percentage of offpump CABG between men and women and no benefit of off-pump CABG for the composite endpoint in both men and women. Previous studies showed an increased risk of adverse outcome in women for CABG on cardiopulmonary bypass, compared to off-pump CABG [4e8, 10,14]. The majority of prior studies included emergency CABGs whereas we excluded these unstable patients, which makes it difficult to directly compare results [4e8,10e15].…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcome in men and women after CABG; results from the IMAGINE trial

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-term outcome in men and women after CABG; results from the IMAGINE trial

et al. 2015

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“…To avoid the problems mentioned above and yet capture the universal quality of care, we used CABG service volumes, risk-adjusted infection rates, and inpatient mortality rates to represent the structure and outcome dimensions respectively. We then applied k-means clustering to help in categorizing quality of care.Relationships among income status, patterns of quality of care, and healthcare outcomesPrevious studies regarding the inequality of CABG outcomes have primarily emphasized differences in gender [46,47] and ethnicity [3,48]. Few studies have discussed the influence of healthcare providers [49].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies regarding the inequality of CABG outcomes have primarily emphasized differences in gender [46,47] and ethnicity [3,48]. Few studies have discussed the influence of healthcare providers [49].…”

Section: Discussionmentioning

confidence: 99%

Do low-income coronary artery bypass surgery patients have equal opportunity to access excellent quality of care and enjoy good outcome in Taiwan?

Hou

Chung

2014

Int J Equity Health

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BackgroundEquity is an important issue in the healthcare research field. Many studies have focused on the relationship between patient characteristics and outcomes of care. These studies, however, have seldom examined whether patients’ characteristics affected their access to quality healthcare, which further affected the care outcome. The purposes of this study were to determine whether low-income coronary artery bypass surgery (CABG) patients receive healthcare services with poorer quality, and if such differences in treatment result in different outcomes.MethodsA retrospective multilevel study design was conducted using claims data from Taiwan’s universal health insurance scheme for 2005-2008. Patients who underwent their CABG surgery between 2006 and 2008 were included in this study. CABG patients who were under 18 years of age or had unknown gender or insured classifications were excluded. Hospital and surgeon’s performance indicators in the previous one year were used to evaluate the level of quality via k-means clustering algorithm. Baron and Kenny’s procedures for mediation effect were conducted to explore the relationship among patient’s income, quality of CABG care, and inpatient mortality.ResultsA total of 10,320 patients were included in the study. The results showed that 5.65% of the low-income patients received excellent quality of care, which was lower than that of patients not in the low-income group (5.65% vs.11.48%). The mortality rate of low-income patients (12.10%) was also higher than patients not in the low-income group (5.25%). Also, the mortality of patients who received excellent care was half as low as patients receiving non-excellent care (2.63% vs. 5.68%). Finally, after the procedure of mediation effect testing, the results showed that the relationship between patient income level and CABG mortality was partially mediated by patterns of quality of care.ConclusionsThe results of the current study implied that worse outcome in low-income CABG patients might be associated with poorer quality of received services. Health authorities should pay attention to this issue, and propose appropriate solutions.

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“…There are also gender 80 and racial disparities 10 in the availability of cardiac surgery care that influence outcomes. Additionally, sociodemographic influences can impair cardiac surgery outcomes.…”

Section: Social Frailtymentioning

confidence: 99%

Cardiac surgery as a stressor and the response of the vulnerable older adult

Neupane

Arora

Rudolph

2017

Experimental Gerontology

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In an aging population, recovery and restoration of function are critical to maintaining independence. Over the past 50 years, there have been dramatic improvements made in cardiac surgery processes and outcomes that allow for procedures to be performed on an increasingly older population with the goal of improving function. Although improved function is possible, major surgical procedures are associated with substantial stress, which can severely impact outcomes. Past literature has identified that frail patients, who are vulnerable to the stress of surgery, are more likely to have postoperative major adverse cardiac and cerebrovascular events (OR 4.9, 95% confidence interval 1.6, 14.6). The objective of this manuscript is to examine preoperative frailty in biological, psychological, and social domains using cardiac surgery to induce stress. We systematically searched PubMed for keywords including “cardiac surgery, frailty, and aged” in addition to the biological, psychological, and social keywords. In the biological domain, we examine the association of physiological and physical vulnerabilities, as well as, the impact of comorbidities and inflammation on negative surgical outcomes. In the psychological domain, the impact of cognitive impairment, depression, and anxiety as vulnerabilities were examined. In the social domain, social structure, coping, disparities, and addiction as vulnerabilities are described. Importantly, there is substantial overlap in the domains of vulnerability. While frailty research has largely focused on discrete physical vulnerability criteria, a broader definition of frailty demonstrates that vulnerabilities in biological, psychological, and social domains can limit recovery after the stress of cardiac surgery. Identification of vulnerability in these domains can allow better understanding of the risks of cardiac surgery and tailoring of interventions to improve outcomes.

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

Abstract: Gender-related disparity in outcome still remains present after surgery with minimized extracorporeal circulation. However, female gender per se is not an independent risk factor for in-hospital mortality, but close attention should be paid on modifiable risk factors.

Cited by 15 publications

References 24 publications

Long-term outcome in men and women after CABG; results from the IMAGINE trial

Long-term outcome in men and women after CABG; results from the IMAGINE trial

Do low-income coronary artery bypass surgery patients have equal opportunity to access excellent quality of care and enjoy good outcome in Taiwan?

Cardiac surgery as a stressor and the response of the vulnerable older adult

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