Bypass Surgery Sidelines Women More
Study finds females suffer more before, during and after procedure
TUESDAY, Oct. 2, 2001 (HealthDayNews) -- Women have good reason to worry about the risks of heart bypass surgery, a new study suggests.
Researchers in Ohio found women who have a coronary artery bypass graft operation have a much tougher time before, during and after the surgery than men who undergo the same procedure do.
The study looked at gender when comparing the outcomes of 5,324 bypass surgeries at a private teaching hospital in Ohio over a period of seven years. The large cohort included 1,742 women and 3,582 men, and the results would make any woman nervous: Women often entered the hospital in worse shape than their male counterparts, they suffered more complications during surgery, and they wound up staying in the hospital longer. The findings will be presented this weekend at the annual meeting of the American Academy of Family Physicians in Atlanta.
"I would say women had more co-morbidities and were more ill at their admission. The women are a lot sicker," says Dr. Scott X. Woods, lead author of the study. "This study doesn't tell you why. It just tells you what's occurring. I think studies like these are more to point out that there are differences between men and women."
In the study, data was collected on each patient for 140 variables that fell into five categories: demographics, medical history, post-operative, reaction with the heart-lung machine and procedure. The researchers measured 13 outcomes: in-hospital death, length of hospital stay, time in intensive care, complications during the operation, return to intensive care, gastrointestinal complications, lung complications, nerve complications, kidney complications, heartbeat irregularities, re-operation for bleeding, positive bacterial cultures and low cardiac output. They also adjusted for 18 other variables, including age, so the influence of gender would be clear.
Here's what they found when they looked at what shape the patients started in:
- Women were much older, more were black, and more were on Medicaid. Their medical condition at admission was often more urgent than the men's.
- Women had much more diabetes, high cholesterol, hypertension and history of stroke.
- Men had much higher body surface area, a measurement of obesity.
- Men also had higher levels of serum creatinine, which is tied to muscle mass.
- Men had more histories of tobacco use and previous heart attacks.
Here's what they found when they looked at the surgeries and outcomes:
- Women had many more complications during the surgery, longer hospital stays and lower cardiac output after surgery.
- Men were more likely to have neurologic complications following surgery.
- When you took body surface area out of the equation, women died much more often than men, Body surface area measurements are considered one of the greatest predictors for heart disease.
But one cardiac expert isn't completely convinced that gender is what's behind the difference.
"I think it's very difficult with a population study. The bottom line is it's very hard to interpret," says Dr. Irving Kron, chief of cardiac surgery at the University of Virginia Medical Center. "This is a question that's been raised over the years. I'm betting it's not just the gender issue."
"Women, adjusted for age, do as well as men. That's my perception and belief," Kron says. "But I think it would be fair to say men, in general, do better than women. But I don't think there's any magic to it. It may be that women are getting sicker later. They tend not to get in trouble quite as soon."
Kron explains that most men get bypass surgery in their 60s, while women tend to be in their 70s. And studies have shown that chances for morbidity following all kinds of operations increases once patients enter their 70s.
But Kron adds, "if you look at just all women and all men, you will see a difference."
And Scott says the difference needs to be addressed.
"The bottom line is, we need to be more proactive with women than men, and we need to be more proactive than we're being with women now," Scott says.
And his message for women is simple: If your doctor suggests such surgery, don't dally.
"Get it earlier rather than later. Don't wait until you're very ill," he says.
What To Do
Read about this 1998 study from the National Heart, Lung, and Blood Institute that found no difference between men and women following bypass surgery.
Read this article from the National Institutes of Health on how women are not watching out for heart disease.
And the American Heart Association has this primer on coronary bypass surgery.