Butterworth J, James R, Prielipp R, Cerese J, Livingston J, Burnett D
Department of Anesthesiology, Wake Forest University School of Medicine and North Carolina Baptist Hospital, Winston-Salem, USA.
Anesthesiology. 2000 Feb;92(2):414-24. doi: 10.1097/00000542-200002000-00023.
Females have worse outcome than do males after coronary artery bypass grafting; however, gender effects on length of stay (LOS) outcomes, such as duration of intubation or intensive care unit (ICU) LOS, have not been evaluated previously. The authors hypothesized that adjustment for pertinent preoperative covariates would eliminate any significant effect of gender on duration of intubation, LOS in the ICU after extubation, total ICU LOS, postoperative (exclusive of ICU) LOS, or total postoperative LOS.
Patients undergoing elective or urgent primary coronary artery bypass grafting surgery at 51 academic health centers in 1995 and 1997 were studied. Unique multivariable statistical models were developed for duration of intubation, ICU LOS after extubation, total ICU LOS, and postoperative (exclusive of ICU and total) LOS to test for independent associations with gender. Preoperative but not intraoperative or postoperative variables were included in the model. P> or =0.01 was considered significant.
All LOSs were of significantly longer duration in females than in males in both the 1995 (n = 1,064) and 1997 (n = 910) data collections. After covariate adjustment, female sex remained associated with significantly longer duration ICU LOS and total postoperative LOS in both the 1995 (female:male ratios 1.30:1 and 1.13:1, respectively) and the 1997 (female:male ratios 1.19:1 and 1.12:1, respectively) data sets. After covariate adjustment, duration of intubation and ICU LOS after extubation were of significantly longer duration in women than men in 1995 (female:male ratios 1.22:1 and 1.39:1, respectively), but the differences were not significant in 1997.
Even in the context of accelerated recovery programs, these analyses show that female sex has powerful associations with increased LOS intervals for coronary artery bypass grafting surgery, even after adjustment for preoperative covariates. These effects could result from differences in the ways in which men and women respond to coronary artery disease, anesthesia, and coronary artery bypass grafting surgery, or to bias on the part of healthcare workers.
冠状动脉搭桥术后女性的预后比男性差；然而，性别对住院时间（LOS）结局的影响，如插管持续时间或重症监护病房（ICU）住院时间，此前尚未得到评估。作者推测，对相关术前协变量进行调整将消除性别对插管持续时间、拔管后ICU住院时间、总ICU住院时间、术后（不包括ICU）住院时间或总术后住院时间的任何显著影响。
对1995年和1997年在51家学术医疗中心接受择期或紧急原发性冠状动脉搭桥手术的患者进行研究。针对插管持续时间、拔管后ICU住院时间、总ICU住院时间和术后（不包括ICU和总计）住院时间建立了独特的多变量统计模型，以测试与性别的独立关联。模型中纳入术前而非术中和术后变量。P≥0.01被认为具有显著性。
在1995年（n = 1064）和1997年（n = 910）的数据收集过程中，所有住院时间在女性中均显著长于男性。经过协变量调整后，在1995年（女性与男性比例分别为1.30:1和1.13:1）和1997年（女性与男性比例分别为1.19:1和1.12:1）的数据集中，女性性别仍与显著更长的ICU住院时间和总术后住院时间相关。经过协变量调整后，1995年女性的插管持续时间和拔管后ICU住院时间显著长于男性（女性与男性比例分别为1.22:1和1.39:1），但在1997年差异不显著。
即使在加速康复计划的背景下，这些分析表明，即使在对术前协变量进行调整后，女性性别与冠状动脉搭桥手术住院时间间隔延长仍有很强的关联。这些影响可能源于男性和女性对冠状动脉疾病、麻醉和冠状动脉搭桥手术反应方式的差异，或医护人员的偏见。
