title: Female gender and the risk for death after cardiac surgery in septuagenarians and octogenarians: a retrospective observational study.
abstract: BACKGROUND
  In elderly patients, the impact of gender on outcome after cardiac surgery is a debated topic of ongoing relevance.
  
  
  OBJECTIVE
  This study assessed the hypothesis that, among septuagenarians and octogenarians, women have poorer outcomes compared with men after cardiac surgery.
  
  
  METHODS
  For this retrospective observational study, the electronic medical records of patients who underwent cardiac surgery between January 2006 and August 2009 at Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany, were reviewed. The primary end points were the proportions of women and men with in-hospital and 30-day mortality, and postoperative morbidity was considered a secondary end point.
  
  
  RESULTS
  The records of 598 patients were reviewed (274 female [137 septuagenarians, 162 octogenarians; mean (SD)] age, 77.8 [4.8] years]; 324 male [137 septuagenarians, 162 octogenarians; mean age, 78.3 [4.8] years]; all, P = NS). At baseline, the gender groups differed significantly with respect to mean logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) (used for calculating expected mortality) (11.9% in women, 9.9% in men; P = 0.007), rate of diabetes mellitus did not reach statistical significance ([statistical significance was considered at P < 0.05] 12.4% vs 7.4%; P = 0.052), rate of renal dysfunction (51.5% vs 28.6%; P < 0.001), proportion undergoing isolated valve surgery (43.1% vs 24.7%, respectively; P < 0.0001), and perfusion technique (conventional [83.2% vs 69.4%] vs minimized [16.8% vs 30.6%] extracorporeal circulation) (P < 0.0001). In-hospital mortality (7.3% vs 5.6%; P = 0.404) and 30-day mortality (8.0% vs 5.9%; P = 0.332) were not significantly different between genders. There were no significant differences in mortality with respect to age group. On multivariate analysis, age and female gender were not found to be independent risk factors for early mortality. The between-gender differences in postoperative morbidity, including central neurologic event (P = 0.412), need for dialysis (P = 0.491), and respiratory insufficiency (P = 1.00), were nonsignificant, as were median durations of intensive care unit stay (P = 0.68) and hospital stay (P = 0.52) stay.
  
  
  CONCLUSIONS
  In septuagenarians and octogenarians, female gender was not associated with increased risks for morbidity and mortality after cardiac surgery.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany. micha.ried@t-online.de
authors.forename: Michael
authors.initials: M
authors.lastname: Ried
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.forename: Tobias
authors.initials: T
authors.lastname: Homann
authors.forename: Philipp
authors.initials: P
authors.lastname: Kolat
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Claudius
authors.initials: C
authors.lastname: Diez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000601:surgery*; D016001:Confidence Intervals; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D016019:Survival Analysis; D016387:Women's Health