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Ann Thorac Surg 1998;66:125-131
© 1998 The Society of Thoracic Surgeons

Original articles: cardiovascular

Impact of gender on coronary bypass operative mortality

Fred H. Edwards, MDa, Joseph S. Carey, MDa,b,c,d,e, Frederick L. Grover, MDa,b,c,d,e, Joseph W. Bero, MSa,b,c,d,e, Renee S. Hartz, MDa,b,c,d,e

a Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, Florida, USA
b Department of Surgery, Torrance Memorial Medical Center, Torrance, California, USA
c University of Colorado Health Science Center, Denver, Colorado, USA
d Summit Medical Systems, Minneapolis, Minnesota, USA; and Department of Surgery
e Tulane Medical School, New Orleans, Louisiana, USA

Accepted for publication February 27, 1998.

Address reprint requests to Dr Edwards, Division of Cardiothoracic Surgery, University of Florida Health Science Center, 653-2 W Eighth St, Jacksonville, FL 32209-6511
e-mail: (fhe{at}mediaone.net)

Background. In spite of many reports investigating the influence of gender on coronary artery operations, it is still uncertain whether gender is an independent risk factor for operative mortality. A major problem of previous reports has centered around the fact that men and women constitute quite different populations, thereby making direct comparisons difficult.

Methods. The Society of Thoracic Surgeons National Cardiac Surgery Database was used to retrospectively examine 344,913 patients undergoing coronary artery bypass graft operations from 1994 through the most recent data harvest. The operative mortality of male and female patients was compared for a variety of single risk factors and combinations of risk factors. A logistic risk model was used to account for all important patient parameters so that individuals could be stratified into comparable categories allowing for direct comparisons of risk-matched male and female patients.

Results. The univariate analysis showed that the 97,153 women carried a significantly higher mortality for each of the risk factors examined. The multivariate analysis and the risk model stratification showed that women had significantly higher mortality as compared to equally matched men in the low- and medium-risk part of the spectrum, but in high-risk patients, there was no difference between male and female mortality.

Conclusions. Gender is an independent predictor of operative mortality except for patients in very high-risk categories.




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 J. Thorac. Cardiovasc. Surg.Home page
J. S. Lawton, S. J. Brister, K. R. Petro, and M. Dullum
Surgical revascularization in women: unique intraoperative factors and considerations
J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 936 - 938.
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 J. Thorac. Cardiovasc. Surg.Home page
L. L. Mickleborough, S. Carson, and J. Ivanov
Gender differences in quality of distal vessels: effect on results of coronary artery bypass grafting
J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 950 - 958.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
C. W. Hogue Jr, R. Lillie, T. Hershey, S. Birge, A. M. Nassief, B. Thomas, and K. E. Freedland
Gender influence on cognitive function after cardiac operation
Ann. Thorac. Surg., October 1, 2003; 76(4): 1119 - 1125.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
C. R. Bridges
Cardiac surgery in African Americans
Ann. Thorac. Surg., October 1, 2003; 76(4): S1356 - 1362.
[Abstract] [Full Text] [PDF]

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 HeartHome page
F C Taylor, R Ascione, K Rees, P Narayan, and G D Angelini
Socioeconomic deprivation is a predictor of poor postoperative cardiovascular outcomes in patients undergoing coronary artery bypass grafting
Heart, September 1, 2003; 89(9): 1062 - 1066.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. L. W. Shroyer, L. P. Coombs, E. D. Peterson, M. C. Eiken, E. R. DeLong, A. Chen, T. B. Ferguson Jr, F. L. Grover, and F. H. Edwards
The society of thoracic surgeons: 30-day operative mortality and morbidity risk models
Ann. Thorac. Surg., June 1, 2003; 75(6): 1856 - 1865.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. Athanasiou, S. Al-Ruzzeh, R. D. Stanbridge, R. P. Casula, B. E. Glenville, and M. Amrani
Is the female gender an independent predictor of adverse outcome after off-pump coronary artery bypass grafting?
Ann. Thorac. Surg., April 1, 2003; 75(4): 1153 - 1160.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
A. K. Jacobs
Coronary Revascularization in Women in 2003: Sex Revisited
Circulation, January 28, 2003; 107(3): 375 - 377.
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 Card Surg AdultHome page
J. A. Fox, V. Formanek, A. Friedrich, and S. K. Shernan
Intraoperative Echocardiography
, January 1, 2003; 2(2003): 283 - 314.
[Full Text]

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 Ann. Thorac. Surg.Home page
P. P. Brown, M. J. Mack, A. W. Simon, S. Battaglia, L. Tarkington, S. Horner, S. D. Culler, and E. R. Becker
Outcomes experience with off-pump coronary artery bypass surgery in women
Ann. Thorac. Surg., December 1, 2002; 74(6): 2113 - 2119.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
P. A. Kurlansky
Invited commentary
Ann. Thorac. Surg., December 1, 2002; 74(6): 2120 - 2120.
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 Ann. Thorac. Surg.Home page
D. Zindrou, K. M. Taylor, and J. P. Bagger
Excess coronary artery bypass graft mortality among women with hypothyroidism
Ann. Thorac. Surg., December 1, 2002; 74(6): 2121 - 2125.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
N. A. Nussmeier, M. R. Marino, and W. K. Vaughn
Hormone replacement therapy is associated with improved survival in women undergoing coronary artery bypass grafting
J. Thorac. Cardiovasc. Surg., December 1, 2002; 124(6): 1225 - 1229.
[Abstract] [Full Text]

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 HeartHome page
P J Bradshaw, K Jamrozik, M Le, I Gilfillan, and P L Thompson
Mortality and recurrent cardiac events after coronary artery bypass graft: long term outcomes in a population study
Heart, December 1, 2002; 88(5): 488 - 494.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
P. A. Kurlansky, E. A. Traad, D. L. Galbut, S. Singer, M. Zucker, and G. Ebra
Coronary bypass surgery in women: a long-term comparative study of quality of life after bilateral internal mammary artery grafting in men and women
Ann. Thorac. Surg., November 1, 2002; 74(5): 1517 - 1525.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
R. Ascione, B. C. Reeves, K. Rees, and G. D. Angelini
Effectiveness of Coronary Artery Bypass Grafting With or Without Cardiopulmonary Bypass in Overweight Patients
Circulation, October 1, 2002; 106(14): 1764 - 1770.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
R.-K. R. Chang, A. Y. Chen, and T. S. Klitzner
Female Sex as a Risk Factor for In-Hospital Mortality Among Children Undergoing Cardiac Surgery
Circulation, September 17, 2002; 106(12): 1514 - 1522.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
J. E. Losanoff, B. W. Richman, and J. W. Jones
Disruption and infection of median sternotomy: a comprehensive review
Eur J Cardiothorac Surg, May 1, 2002; 21(5): 831 - 839.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
M. A. Williams, J. L. Fleg, P. A. Ades, B. R. Chaitman, N. H. Miller, S. M. Mohiuddin, I. S. Ockene, C. B. Taylor, and N. K. Wenger
Secondary Prevention of Coronary Heart Disease in the Elderly (With Emphasis on Patients >=75 Years of Age): An American Heart Association Scientific Statement From the Council on Clinical Cardiology Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention
Circulation, April 9, 2002; 105(14): 1735 - 1743.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
Y. Zitser-Gurevich, E. Simchen, N. Galai, and M. Mandel
Effect of perioperative complications on excess mortality among women after coronary artery bypass: The Israeli Coronary Artery Bypass Graft study (ISCAB)
J. Thorac. Cardiovasc. Surg., March 1, 2002; 123(3): 517 - 524.
[Abstract] [Full Text] [PDF]

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 Cardiovasc ResHome page
N. K Wenger
Clinical characteristics of coronary heart disease in women: emphasis on gender differences
Cardiovasc Res, February 15, 2002; 53(3): 558 - 567.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
N.A. Nussmeier, W.Y. Thong, M.R. Marino, C.L. Williams, and W.K. Vaughn
Hormone replacement therapy improves the survival of women undergoing coronary artery bypass grafting
Ann. Thorac. Surg., January 1, 2002; 73(1): S371 - 371.
[Full Text] [PDF]

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 Diabetes CareHome page
D. Zindrou, K. M. Taylor, and J. P. Bagger
Admission Plasma Glucose: An independent risk factor in nondiabetic women after coronary artery bypass grafting
Diabetes Care, September 1, 2001; 24(9): 1634 - 1639.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
P. A. Kurlansky, E. A. Traad, D. L. Galbut, M. Zucker, and G. Ebra
Efficacy of single versus bilateral internal mammary artery grafting in women: a long-term study
Ann. Thorac. Surg., June 1, 2001; 71(6): 1949 - 1958.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
C. W. Hogue Jr, B. Barzilai, K. S. Pieper, L. P. Coombs, E. R. DeLong, N. T. Kouchoukos, and V. G. Davila-Roman
Sex Differences in Neurological Outcomes and Mortality After Cardiac Surgery : A Society of Thoracic Surgery National Database Report
Circulation, May 1, 2001; 103(17): 2133 - 2137.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
D. J. O'Rourke, D. J. Malenka, E. M. Olmstead, H. B. Quinton, J. H. Sanders Jr, S. J. Lahey, M. Norotsky, R. D. Quinn, Y. R. Baribeau, F. Hernandez Jr, et al.
Improved in-hospital mortality in women undergoing coronary artery bypass grafting
Ann. Thorac. Surg., February 1, 2001; 71(2): 507 - 511.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
R. S. Hartz, A. V. Rao, M. E. Plomondon, F. L. Grover, and A. L. W. Shroyer
Effects of race, with or without gender, on operative mortality after coronary artery bypass grafting: a study using The Society of Thoracic Surgeons national database
Ann. Thorac. Surg., February 1, 2001; 71(2): 512 - 520.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. A. Schwann, R. H. Habib, A. Zacharias, G. L. Parenteau, C. J. Riordan, S. J. Durham, and M. Engoren
Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation
Ann. Thorac. Surg., February 1, 2001; 71(2): 521 - 530.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
B. C. Astor, R. G. Kaczmarek, B. Hefflin, and W. R. Daley
Mortality after aortic valve replacement: results from a nationally representative database
Ann. Thorac. Surg., December 1, 2000; 70(6): 1939 - 1945.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
D. Abramov, M. G. Tamariz, J. Y. Sever, G. T. Christakis, G. Bhatnagar, A. L. Heenan, B. S. Goldman, and S. E. Fremes
The influence of gender on the outcome of coronary artery bypass surgery
Ann. Thorac. Surg., September 1, 2000; 70(3): 800 - 805.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
R. D. Stewart, C. T. Campos, B. Jennings, S. S. Lollis, S. Levitsky, and S. J. Lahey
Predictors of 30-day hospital readmission after coronary artery bypass
Ann. Thorac. Surg., July 1, 2000; 70(1): 169 - 174.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
C. S. Roberts
Postoperative drug therapy to extend survival after coronary artery bypass grafting
Ann. Thorac. Surg., May 1, 2000; 69(5): 1315 - 1316.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. B. Ferguson Jr, S. W. Dziuban Jr, F. H. Edwards, M. C. Eiken, A. L. W. Shroyer, P. C. Pairolero, R. P. Anderson, and F. L. Grover
The STS National Database: current changes and challenges for the new millennium
Ann. Thorac. Surg., March 1, 2000; 69(3): 680 - 691.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. T. Pezzella
Reduction of wound healing problems after median sternotomy by use of retention sutures
Ann. Thorac. Surg., November 1, 1999; 68(5): 1891 - 1892.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
O. L. Godje, P. Lamm, T. Lange, and B. Reichart
Reply
Ann. Thorac. Surg., November 1, 1999; 68(5): 1892 - 1892.
[Full Text] [PDF]


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