Girls Have Higher Death Rates After Heart Surgery

Study finds that even youth doesn't diminish risk

MONDAY, Sept. 16, 2002 (HealthDayNews) -- A California study adds emphasis to a major medical puzzle about heart surgery: Why should being female substantially increase the risk of death?

A study of almost 7,000 patients who had heart surgery in 20 California hospitals over a three-year period shows that females under the age of 21 had a 51 percent higher death rate than young males, researchers at the Harbor-UCLA Medical Center report in tomorrow's issue of Circulation: Journal of the American Heart Association.

One reason the study was done is that the risk of death was known to be highly imbalanced for adult women who have cardiac surgery, with their death rate at least 50 percent higher than for male patients, says Dr. Ruey-Kang R. Chang, a principal investigator at the Harbor-UCLA Research and Education Institute and lead author of the report.

"We wanted to find out if such a difference as seen in adults occurs in children," Chang says. "It came out as a surprise that the difference is so dramatic."

There are two possible explanations for the difference, Chang says. One is biological, with hormones or some other sex-related characteristics accounting for the increased risk. The other is that utilization of health-care services is different.

If it is a health-care difference, what happens in the hospital at the time of surgery is not the cause, Chang says. "We found that the delivery of services in the hospital was similar for both sexes," he says. "That suggests the difference might come from biological factors, but we're not sure about it."

"It's a mystery," agrees Dr. Catherine Webb, a pediatric cardiologist at Children's Memorial Hospital in Chicago and a spokeswoman for the American Heart Association. But there are a few suggestions about a solution to the mystery, she says.

One is that "females tend to have more co-morbid conditions," Webb says, medical problems such as pulmonary hypertension that make them more vulnerable. Still, there is no definitive answer to the question, she adds.

Finding an answer could help future female heart patients, Chang says. "If we know where the differences are coming from, we can change the way we practice," he says. "The next step is to find the reasons."

Chang and his colleagues have gotten financial support for a new study that will examine the causes of the gender difference. "That could change the way we treat patients," he says.

But Webb says one group of heart surgery candidates probably will not be affected by any new findings. These are the very young, children under the age of 1, in whom the death rate was especially high. In that vulnerable group, she says, "we do not recommend surgery unless it is absolutely necessary. And the younger you are, the more chance you run of not surviving."

What To Do

Get statistics on heart surgery from the American Heart Association, which also has a page on heart disease in children.

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