Sex differences in neurological outcomes and mortality after cardiac surgery: a society of thoracic surgery national database report.
BACKGROUND
The purpose of this study was to evaluate whether women undergoing cardiac surgery are more likely to suffer neurological complications than men and whether these complications could explain, at least in part, their higher perioperative mortality.


RESULTS
The Society of Thoracic Surgery National Cardiac Surgery Database was examined for the years 1996 and 1997 to determine the frequency of new neurological events (stroke, transient ischemic attack, or coma) occurring after cardiac surgery. We reviewed clinical information on 416 347 patients (32% women) for whom complete neurological outcome data were available. New neurological events after surgery were higher for women than for men (3.8% versus 2.4%, P=0.001). For the whole group, the 30-day mortality was higher for women than for men (5.7% versus 3.5%, P=0.001), and among those patients who suffered a perioperative neurological event, mortality was also significantly higher for women than men (32% versus 28%, P=0.001). After adjustment for other risk factors (eg, age, history of hypertension and/or diabetes, duration of cardiopulmonary bypass, and other comorbid conditions) by multivariable logistic regression, female sex was independently associated with significantly higher risk of suffering new neurological events after cardiac surgery (OR 1.21, 95% CI 1.14 to 1.28, P=0.001).


CONCLUSIONS
Women undergoing cardiac surgery are more likely than men to suffer new perioperative neurological events, and they have higher 30-day mortality when these complications occur. The higher incidence of perioperative neurological complications in women cannot be explained by currently known risk factors.
Hogue
C W
CW
Department of Anesthesiology, Cardiovascular Division, Washington University School of Medicine, St Louis, MO, USA.
Barzilai
B
B
Pieper
K S
KS
Coombs
L P
LP
DeLong
E R
ER
Kouchoukos
N T
NT
Dávila-Román
V G
VG
D000328:Adult; D000368:Aged; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D001927:Brain Diseases / Q000453:epidemiology* / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D003128:Coma / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology