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. 2024 Apr 20;24(1):215.
doi: 10.1186/s12872-024-03862-7.

Days alive and out of hospital for adult female and male cardiac surgery patients: a population-based cohort study

Angela Jerath  1   2   3   4 , Christopher J D Wallis  5   6   7 , Stephen Fremes  8   9   10 , Vivek Rao  11   12   10 , Terrence M Yau  12   10 , Kiyan Heybati  13 , Douglas S Lee  14   12   15 , Harindra C Wijeysundera  14   8 , Jason Sutherland  16 , Peter C Austin  14 , Duminda N Wijeysundera  14   17 , Dennis T Ko  14   8
Affiliations

Days alive and out of hospital for adult female and male cardiac surgery patients: a population-based cohort study

Angela Jerath et al. BMC Cardiovasc Disord. .

Erratum in

Abstract

Background: Research shows women experience higher mortality than men after cardiac surgery but information on sex-differences during postoperative recovery is limited. Days alive and out of hospital (DAH) combines death, readmission and length of stay, and may better quantify sex-differences during recovery. This main objective is to evaluate (i) how DAH at 30-days varies between sex and surgical procedure, (ii) DAH responsiveness to patient and surgical complexity, and (iii) longer-term prognostic value of DAH.

Methods: We evaluated 111,430 patients (26% female) who underwent one of three types of cardiac surgery (isolated coronary artery bypass [CABG], isolated non-CABG, combination procedures) between 2009 - 2019. Primary outcome was DAH at 30 days (DAH30), secondary outcomes were DAH at 90 days (DAH90) and 180 days (DAH180). Data were stratified by sex and surgical group. Unadjusted and risk-adjusted analyses were conducted to determine the association of DAH with patient-, surgery-, and hospital-level characteristics. Patients were divided into two groups (below and above the 10th percentile) based on the number of days at DAH30. Proportion of patients below the 10th percentile at DAH30 that remained in this group at DAH90 and DAH180 were determined.

Results: DAH30 were lower for women compared to men (22 vs. 23 days), and seen across all surgical groups (isolated CABG 23 vs. 24, isolated non-CABG 22 vs. 23, combined surgeries 19 vs. 21 days). Clinical risk factors including multimorbidity, socioeconomic status and surgical complexity were associated with lower DAH30 values, but women showed lower values of DAH30 compared to men for many factors. Among patients in the lowest 10th percentile at DAH30, 80% of both females and males remained in the lowest 10th percentile at 90 days, while 72% of females and 76% males remained in that percentile at 180 days.

Conclusion: DAH is a responsive outcome to differences in patient and surgical risk factors. Further research is needed to identify new care pathways to reduce disparities in outcomes between male and female patients.

Keywords: Cardiac surgery; Days at home; Epidemiology; Outcomes; Sex; Validation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Forest plot showing risk adjusted effects of patient, surgical and hospital factors on days at alive and out of hospital (DAH) at 30 days
See this image and copyright information in PMC

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