Gender's impact on outcome in coronary surgery with minimized extracorporeal circulation.
BACKGROUND
The role of female gender in cardiac surgery is still controversial. We examined the impact of gender on mortality after coronary artery bypass grafting (CABG) with minimized extracorporeal circulation (MECC).


METHODS
Between January 2004 and May 2009, 1,662 patients (439 females, 1,223 males) underwent CABG with MECC at the University Medical Center Regensburg. Perioperative data were retrospectively analyzed; primary end point was in-hospital mortality.


RESULTS
At operation, women were older, had a higher prevalence of diabetes and impaired renal function, and underwent more often non-elective surgery. Unadjusted mortality was significantly lower for men and than for women (2.3 vs. 5.7%; p = 0.001). Risk-adjusted mortality rates were derived by stepwise logistic regression. The final model reduced the gender-related mortality gap from 147 to 32%. Goodness of fit and discriminatory performance (AUC = 0.83) were good. Female gender, however, could not be identified as an independent risk factor for adverse outcome (OR 1.6; 95% CI 0.8-3.4). Risk-adjusted mortality was calculated as 4.9% in females and 2.6% in males. Low body surface area (<1.66 m(2)) was associated with excess mortality in females.


CONCLUSIONS
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.
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. micha.ried@t-online.de
Michael
M
Ried
Dirk
D
Lunz
Reinhard
R
Kobuch
Leopold
L
Rupprecht
Andreas
A
Keyser
Michael
M
Hilker
Christof
C
Schmid
Claudius
C
Diez
D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001830:Body Surface Area; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005112:Extracorporeal Circulation / Q000379:methods* / Q000401:mortality; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051437:Renal Insufficiency / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome