Women are more likely to die after complications from heart surgery than men

When a patient dies from complications after surgery, it is often referred to as a “failed lifesaving attempt.”

Researchers evaluated more than 850,000 Medicare beneficiaries who underwent high-risk heart surgery, including heart bypass surgery, aortic aneurysm repair, and mitral and aortic valve repair between 2015 and 2020. did.

The incidence of complications after surgery was similar for men and women, approximately 15%.

However, women were significantly more likely to die from these complications: the surgical team was unable to save a female patient 10.7% of the time, compared to 8.6% of the time for a male patient.

The result is JAMA surgery.

“This is a problem across the U.S. health care system. We are failing to save women from high-risk surgeries, even though their rates of post-operative complications are similar to those of men,” said Kathryn. said M. Wagner, MD. is the lead author and a resident in integrative thoracic surgery at the University of Michigan Health.

“If we want to reduce gender disparities after high-risk surgery, we need to improve our awareness and response to these complications.”

The researchers found a similar pattern in failure rates for each individual procedure.

The most common complications in men and women were kidney failure, pneumonia, and lung failure.

The quality of the hospital where the surgery was performed did not influence the failure to remedy the gender disparity.

In fact, the women in the study were more likely to have their surgery at a hospital that traditionally undertakes more high-risk surgeries.

“Although these high-risk procedures are expected to have an inherently high complication rate, patients are still expected to have good outcomes if complications are managed quickly.” said author Gorav Airawadi, MD, MBA, chief of cardiac surgery at UM Health. Director, Frankel Heart and Vascular Center, University of Michigan Health

“In our study, female patients had lower reoperation rates than men,” she added, using the term to mean a second surgery within a few days of the first.

“This is not due to a lower need for reoperation, but may indicate that complications are not being adequately addressed.”

Researchers have shown for years that women are more likely to die after cardiovascular surgery.

Explanations to date have largely centered on the fact that women undergo surgery at an older age and have more complications than men.

Women also have smaller anatomy and smaller blood vessel sizes, which can make surgery technically more difficult.

This difference adds to previous research showing that signs and symptoms of common illnesses such as heart attacks and strokes are often overlooked or not taken seriously in female patients. .

“After taking into account patient comorbidities and patient risks, we found that men and women have similar rates and types of complications, but women are still more likely to die from those complications. “It's highly likely that it's more likely to be a disease,” said co-author Andrew Ibrahim, M.D., Ph.D. , associate professor of surgery at the U-M School of Medicine and co-director of Health Outcomes and Policy at Michigan Medical Center.

“In addition to reducing overall complications, we must focus on what happens after a complication occurs. Similarly, after surgery, if a female patient suffers a complication, we must focus on what happens after the complication occurs. , we have the opportunity to recognize it early, before it cascades to the point where it is no longer salvageable.''To reduce long-standing disparities in outcomes after high-risk surgery, we have the opportunity to recognize post-operative complications, especially for women. We need to improve our awareness and response to ”

For many years, women have been underrepresented in medical research.

In June 2016, the National Institutes of Health introduced a policy requiring the inclusion of gender as a biological variable in research design, analysis, and reporting.

“In addition to taking steps at the health system level to reduce this disparity, we are also working to address the long-standing neglect of women’s health and identify underlying mechanisms that, if addressed, can improve outcomes for all patients. We must continue to investigate gender differences in biomedical research,” Wagner said.