Ried Michael, Haneya Assad, Homann Tobias, Kolat Philipp, Schmid Christof, Diez Claudius
Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany.
Gend Med. 2011 Aug;8(4):252-60. doi: 10.1016/j.genm.2011.05.003. Epub 2011 Jun 11.
In elderly patients, the impact of gender on outcome after cardiac surgery is a debated topic of ongoing relevance.
This study assessed the hypothesis that, among septuagenarians and octogenarians, women have poorer outcomes compared with men after cardiac surgery.
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.
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.
In septuagenarians and octogenarians, female gender was not associated with increased risks for morbidity and mortality after cardiac surgery.
在老年患者中，性别对心脏手术后结局的影响是一个仍具相关性且存在争议的话题。
本研究评估了以下假设：在七旬和八旬老人中，心脏手术后女性的结局比男性差。
在这项回顾性观察研究中，对2006年1月至2009年8月期间在德国雷根斯堡大学医学中心心胸外科接受心脏手术的患者的电子病历进行了回顾。主要终点是住院和30天死亡率的男女比例，术后发病率被视为次要终点。
共回顾了598例患者的记录（274例女性[137例七旬老人，162例八旬老人；平均（标准差）年龄，77.8 [4.8]岁]；324例男性[137例七旬老人，162例八旬老人；平均年龄，78.3 [4.8]岁]；总体，P =无显著差异）。在基线时，性别组在平均逻辑欧洲心脏手术风险评估系统评分（EuroSCORE）（用于计算预期死亡率）方面存在显著差异（女性为11.9%，男性为9.9%；P = 0.007），糖尿病发生率未达到统计学意义（[P < 0.05时认为具有统计学意义] 12.4%对7.4%；P = 0.052），肾功能不全发生率（51.5%对28.6%；P < 0.001），接受单纯瓣膜手术的比例（分别为43.1%对24.7%；P < 0.0001），以及灌注技术（传统[83.2%对69.4%]对体外循环最小化[16.8%对30.6%]）（P < 0.0001）。住院死亡率（7.3%对5.6%；P = 0.404）和30天死亡率（8.0%对5.9%；P = 0.332）在性别之间无显著差异。不同年龄组之间的死亡率无显著差异。多因素分析显示，年龄和女性性别不是早期死亡的独立危险因素。术后发病率的性别差异，包括中枢神经系统事件（P = 0.412）、透析需求（P = 0.491）和呼吸功能不全（P = 1.00）均无统计学意义，重症监护病房住院时间中位数（P = 0.68）和住院时间中位数（P = 0.52）也是如此。
在七旬和八旬老人中，女性性别与心脏手术后发病和死亡风险增加无关。
