Koch C G, Higgins T L, Capdeville M, Maryland P, Leventhal M, Starr N J
Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, OH 44195-5076, USA.
J Cardiothorac Vasc Anesth. 1996 Dec;10(7):839-43. doi: 10.1016/s1053-0770(96)80042-5.
To evaluate the effect of gender on outcomes of coronary artery bypass surgery using a weighted preoperative severity of illness scoring system.
Retrospective database review.
Tertiary care teaching hospital.
The patient population consisted of 2,800 consecutive coronary artery bypass graft (CABG) patients (658 women, 2,142 men), with or without concurrent procedures, operated on between January 1, 1993 and March 31, 1994.
Patients were stratified for severity of illness using a 13-element scoring system. The distribution of severity of illness scores and severity of illness-stratified morbidity, hospital mortality, and intensive care unit (ICU) length of stay were compared by chi-square and Fischer's exact test where appropriate. Median duration of intubation and median duration of ICU length of stay were examined by the median test. Female versus male unadjusted mortality (4.9% v 3.0%), total morbidity (15.0% v 9.2%), and average initial ICU length of stay (92.62% v 60.56 hours) were statistically different. Female patients also had significantly more of the following postoperative morbidities: central nervous system complications (focal neurologic deficits, patients > or = 65 years 3.20% v 1.54%; global neurologic deficits, patients > or = 65 years 2.75% v 1.25%), duration of perioperative ventilation that includes the intubation time in the operating room until extubation in the ICU (average = 77.36 hours v 49.20 hours; median = 21.87 v 20.26 hours), and average initial ICU length of stay (average = 92.62 hours v 60.56 hours; median = 42.33 hours v 27.91 hours). However, distribution of severity scores was also different. Women had significantly more preoperative risk factors (p < 0.05): age 65 to 74 years (45.1% v 36.6%), age > or = 75 years (21.3% v 11.9%), chronic obstructive pulmonary disease (10.8% v 6.4%), hematocrit less than 34% (21.9% v 5.5%), diabetes (34.8% v 21.8%), weight less than 65 kg (37.4% v 6.2%), and operative mitral valve insufficiency (9.6% v 6.0%). Stratified by severity, no statistically significant gender differences were found for mortality, morbidity, or ICU length of stay.
Gender does not appear to be an independent risk factor for perioperative morbidity, mortality, or excessive ICU length of stay when patients are stratified by preoperative risk in this severity of illness scoring system.
采用术前疾病严重程度加权评分系统评估性别对冠状动脉搭桥手术结果的影响。
回顾性数据库分析。
三级护理教学医院。
患者群体包括1993年1月1日至1994年3月31日期间连续接受冠状动脉搭桥术（CABG）的2800例患者（658例女性，2142例男性），无论是否同时进行其他手术。
采用13项评分系统对患者的疾病严重程度进行分层。在适当情况下，通过卡方检验和费舍尔精确检验比较疾病严重程度评分的分布以及按疾病严重程度分层的发病率、医院死亡率和重症监护病房（ICU）住院时间。通过中位数检验检查插管的中位持续时间和ICU住院时间的中位数。女性与男性未经调整的死亡率（4.9%对3.0%）、总发病率（15.0%对9.2%）以及平均初始ICU住院时间（92.62小时对60.56小时）存在统计学差异。女性患者术后还存在以下更多的并发症：中枢神经系统并发症（局灶性神经功能缺损，年龄≥65岁患者3.20%对1.54%；全身性神经功能缺损，年龄≥65岁患者2.75%对1.25%）、围手术期通气时间（包括在手术室插管至在ICU拔管的时间）（平均=77.36小时对49.20小时；中位数=21.87对20.26小时）以及平均初始ICU住院时间（平均=92.62小时对60.56小时；中位数=42.33小时对27.91小时）。然而，严重程度评分的分布也有所不同。女性术前危险因素明显更多（p<0.05）：年龄65至74岁（45.1%对36.6%）、年龄≥75岁（21.3%对11.9%）、慢性阻塞性肺疾病（10.8%对6.4%）、血细胞比容低于34%（21.9%对5.5%）、糖尿病（34.8%对21.8%）、体重低于65kg（37.4%对6.2%）以及手术时二尖瓣关闭不全（9.6%对6.0%）。按严重程度分层后，在死亡率、发病率或ICU住院时间方面未发现性别差异有统计学意义。
在该疾病严重程度评分系统中，当根据术前风险对患者进行分层时，性别似乎不是围手术期发病率、死亡率或ICU住院时间过长的独立危险因素。
