Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
JAMA Surg. 2023 May 1;158(5):494-502. doi: 10.1001/jamasurg.2022.8156.
It has been reported that women undergoing coronary artery bypass have higher mortality and morbidity compared with men but it is unclear if the difference has decreased over the last decade.
To evaluate trends in outcomes of women undergoing coronary artery bypass in the US from 2011 to 2020.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study at hospitals contributing to the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons included 1 297 204 patients who underwent primary isolated coronary artery bypass from 2011 to 2020.
Coronary artery bypass.
The primary outcome was operative mortality. The secondary outcome was the composite of operative mortality and morbidity (including operative mortality, stroke, kidney failure, reoperation, deep sternal wound infection, prolonged mechanical ventilation, and prolonged hospital stay). The attributable risk (the association of female sex with coronary artery bypass grafting outcomes) for the primary and secondary outcomes was calculated.
Between 2011 and 2020, 1 297 204 patients underwent primary isolated coronary artery bypass grafting with a mean age of 66.0 years, 317 716 of which were women (24.5%). Women had a higher unadjusted operative mortality (2.8%; 95% CI, 2.8-2.9 vs 1.7%; 95% CI, 1.7-1.7; P < .001) and overall unadjusted incidence of the composite of operative mortality and morbidity compared with men (22.9%; 95% CI, 22.7-23.0 vs 16.7%; 95% CI, 16.6-16.8; P < .001). The attributable risk of female sex for operative mortality varied from 1.28 in 2011 to 1.41 in 2020, with no significant change over the study period (P for trend = 0.38). The attributable risk for the composite of operative mortality and morbidity was 1.08 in both 2011 and 2020 with no significant change over the study period (P for trend = 0.71).
Women remain at significantly higher risk for adverse outcomes following coronary artery bypass grafting and no significant improvement has been seen over the course of the last decade. Further investigation into the determinants of operative outcomes in women is urgently needed.
据报道，女性行冠状动脉旁路移植术的死亡率和发病率高于男性，但尚不清楚这种差异是否在过去十年中有所降低。
评估 2011 年至 2020 年美国女性行冠状动脉旁路移植术的结局趋势。
设计、地点和参与者：这项回顾性队列研究在为胸外科医师学会成人心脏手术数据库提供数据的医院进行，共纳入 1297204 例 2011 年至 2020 年期间接受单纯冠状动脉旁路移植术的患者。
冠状动脉旁路移植术。
主要结局是手术死亡率。次要结局是手术死亡率和发病率的复合结局（包括手术死亡率、卒、肾衰竭、再次手术、深部胸骨伤口感染、机械通气延长和住院时间延长）。计算归因风险（女性性别与冠状动脉旁路移植术结局的关联）用于主要和次要结局。
在 2011 年至 2020 年期间，1297204 例患者接受了单纯冠状动脉旁路移植术，平均年龄为 66.0 岁，其中 317716 例为女性（24.5%）。女性的未校正手术死亡率（2.8%；95%CI，2.8-2.9 与 1.7%；95%CI，1.7-1.7；P<0.001）和总体未校正手术死亡率和发病率的复合结局发生率高于男性（22.9%；95%CI，22.7-23.0 与 16.7%；95%CI，16.6-16.8；P<0.001）。女性性别与手术死亡率的归因风险从 2011 年的 1.28 变化至 2020 年的 1.41，研究期间无显著变化（趋势 P 值=0.38）。手术死亡率和发病率复合结局的归因风险在 2011 年和 2020 年均为 1.08，研究期间无显著变化（趋势 P 值=0.71）。
女性行冠状动脉旁路移植术后的不良结局风险仍然显著升高，在过去十年中没有明显改善。迫切需要进一步研究女性手术结局的决定因素。
