Vassileva Christina M, Stelle Lacey M, Markwell Steve, Boley Theresa, Hazelrigg Stephen
Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9638, USA.
Heart Surg Forum. 2011 Oct;14(5):E276-82. doi: 10.1532/HSF98.20111030.
There is a paucity of data on sex differences in procedure selection and outcomes of patients undergoing mitral valve surgery.
The National Inpatient Sample database from 2005 to 2008 was searched to identify patients ≥30 years of age who underwent mitral valve repair or replacement (ICD-9-CM codes 35.12, 35.23, and 35.24). Women constituted 51.6% of the patients, and they were older, were less affluent, had higher values for the Charlson comorbidity index, and more often presented on an urgent/emergent basis. Women underwent repair less often than men (37.9% versus 55.9%, P < .001) and more often underwent concomitant tricuspid surgery or a Maze procedure. After adjustment for propensity scores, women were more likely to undergo replacement (odds ratio, 1.78; 95% confidence interval, 1.64-1.93; P = .0001), they had longer lengths of stay, and less favorable disposition. Among the patients who underwent mitral valve repair, women had a higher hospital mortality (2.06% versus 1.36%, P = .0328). After adjustment for propensity scores and concomitant procedures, this relationship was no longer statistically significant.
Women are less likely than men to receive mitral valve repair. Although the higher hospital mortality of women presenting for mitral valve surgery was accounted for by their worse preoperative profiles, this sex disparity reflects the current reality in surgical practice and identifies an important area for future improvement in the care of patients with valvular heart disease.
关于二尖瓣手术患者在手术选择和预后方面的性别差异，相关数据较少。
检索2005年至2008年的国家住院患者样本数据库，以确定年龄≥30岁且接受二尖瓣修复或置换手术的患者（国际疾病分类第九版临床修正本编码35.12、35.23和35.24）。女性占患者总数的51.6%，她们年龄更大，经济状况较差，Charlson合并症指数更高，且更常以紧急/急诊情况就诊。女性接受修复手术的比例低于男性（37.9%对55.9%，P<.001），且更常接受同期三尖瓣手术或迷宫手术。在对倾向得分进行调整后，女性更有可能接受置换手术（优势比，1.78；95%置信区间，1.64 - 1.93；P =.零零零一），她们的住院时间更长，出院情况也较差。在接受二尖瓣修复的患者中，女性的院内死亡率更高（2.06%对1.36%，P =.0328）。在对倾向得分和同期手术进行调整后，这种关系不再具有统计学意义。
女性接受二尖瓣修复手术的可能性低于男性。尽管二尖瓣手术女性患者较高的院内死亡率是由其较差的术前情况所致，但这种性别差异反映了当前手术实践中的现实情况，并确定了瓣膜性心脏病患者护理未来需要改进的一个重要领域。
