Seifert Harry A, Howard David L, Silber Jeffrey H, Jobes David R
Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA.
J Thorac Cardiovasc Surg. 2007 Mar;133(3):668-75. doi: 10.1016/j.jtcvs.2006.11.014.
The study objective was to determine whether gender is a determinant of in-hospital mortality after surgery to repair congenital heart disease in patients aged 20 years or less. Secondary objectives were to determine other factors associated with increased risk of death and whether female gender is associated with increased length of stay or total charges.
The study included a retrospective cohort consisting of all records indicating cardiac operations within the Healthcare Cost and Utilization Project Kids' Inpatient Database for the year 2000. Logistic regression was used to simultaneously evaluate the effect of gender on the risk of death while adjusting for all other factors being considered. Logistic regression was then used to evaluate possible differences in length of stay or total charges.
Female gender was associated with increased risk of in-hospital death when all of the other measured factors were taken into consideration (odds ratio 1.31, 95% confidence interval 1.02-1.69). Other factors that were significantly associated with increased in-hospital mortality after pediatric cardiac surgery included the number of days between admission and operation; African American race; young age (neonates and infants compared with children aged > or =1 year); pulmonary hypertension; and the Norwood operation. There were no significant gender differences in risk-adjusted length of stay or total charges.
In-hospital mortality after pediatric cardiac surgery seems to be associated with patient gender but not with the type of insurance or ability to access higher-volume pediatric facilities or teaching hospitals.
本研究旨在确定性别是否为20岁及以下先天性心脏病修补术后住院死亡率的决定因素。次要目的是确定与死亡风险增加相关的其他因素，以及女性性别是否与住院时间延长或总费用增加相关。
本研究纳入了一个回顾性队列，包括2000年医疗成本和利用项目儿童住院数据库中所有表明进行心脏手术的记录。使用逻辑回归同时评估性别对死亡风险的影响，同时对所有其他考虑因素进行调整。然后使用逻辑回归评估住院时间或总费用的可能差异。
当考虑所有其他测量因素时，女性性别与住院死亡风险增加相关（比值比1.31，95%置信区间1.02 - 1.69）。小儿心脏手术后与住院死亡率增加显著相关的其他因素包括入院与手术之间的天数；非裔美国人种族；年龄小（新生儿和婴儿与年龄≥1岁的儿童相比）；肺动脉高压；以及诺伍德手术。在风险调整后的住院时间或总费用方面，没有显著的性别差异。
小儿心脏手术后的住院死亡率似乎与患者性别有关，但与保险类型或获得更高容量小儿设施或教学医院的能力无关。
