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. 2024 Aug;121(8):e20240012.
doi: 10.36660/abc.20240012.

More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement

[Article in Portuguese, English]
Leonardo Lacava  1   2 , Fabiane Letícia de Freitas  2 , Gabrielle Barbosa Borgomoni  2 , Pedro Gabriel Melo de Barros E Silva  3 , Marcelo Arruda Nakazone  4 , Valquiria Pelisser Campagnucci  5 , Marcos Gradim Tiveron  6 , Luiz Augusto Lisboa  2 , Fabio Biscegli Jatene  2 , Omar Asdrúbal Vilca Mejia  2   3
Affiliations

More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement

[Article in Portuguese, English]
Leonardo Lacava et al. Arq Bras Cardiol. 2024 Aug.

Abstract
in English, Portuguese

Background: Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness.

Objective: To compare adjusted hospital outcomes between men and women undergoing CABG.

Methods: From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05.

Results: After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03).

Conclusions: Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

Fundamento: Análises em grandes registros apontam desfechos desfavoráveis para mulheres submetidas à cirurgia de revascularização do miocárdio (CRM), enquanto estudos randomizados sofrem com a falta de representatividade.

Objetivo: Comparar os resultados hospitalares ajustados entre homens e mulheres submetidos à CRM.

Métodos: Entre julho de 2017 e junho de 2019, 3991 pacientes foram submetidos à CRM primária isolada, tanto de forma eletiva como de urgência, em 5 hospitais de estado de São Paulo, Brasil. Para equilibrar as diferenças entre homens e mulheres, as populações foram ajustadas utilizando o Propensity Score Matching. Os desfechos considerados para análise foram os utilizados pelo STS Adult Database. As análises foram conduzidas no software R, considerando significância valores de p < 0,05.

Resultados: Após o Propensity Score Matching (1:1), cada grupo incluiu 1089 pacientes. Em relação às variáveis intraoperatórias os homens apresentaram maior tempo de CEC (p<0,001), tempo cirúrgico (p<0,001), número de anastomoses distais (p<0,001) e uso de enxertos arteriais. Em relação aos desfechos as mulheres apresentaram maior incidência de infecção de ferida profunda (p=0,006), tempo prolongado na Unidade de Terapia Intensiva (p=0,002), maior necessidade do uso de balão intraórtico (p=0,04), maior taxa de transfusão sanguínea (p<0,001), maior readmissão hospitalar em até 30 dias após a cirurgia (p=0,002) e maior taxa de óbitos (p=0,03).

Conclusões: Apesar dos homens terem apresentado um maior tempo de CEC, maior número de enxertos arteriais e maior número de anastomoses distais, os resultados imediatos após CRM foram piores em mulheres.

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Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo.

Figures

Figura Central
Figura Central. : Mais Complicações em Mulheres após Revascularização do Miocárdio Mesmo com Tempos Cirúrgicos Reduzidos: Atenção por Equidade e Melhoria da Qualidade
Figura 1
Figura 1. – Fluxograma do estudo.
Figura 2
Figura 2. – Mortalidade predita e observada antes e após o Propensity score matching. STS: Society of Thoracic Surgeons Risk Calculator; PSM: Propensity score matching.
Central Illustration
Central Illustration. : More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement
Figure 1
Figure 1. – Study flowchart.
Figure 2
Figure 2. – Predicted and observed mortality before and after Propensity score matching. STS: Society of Thoracic Surgeons Risk Calculator; PSM: Propensity score matching.
See this image and copyright information in PMC

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