While male and female patients have similar rates of serious complications following high-risk vascular and cardiac surgery, female patients may be more likely to die following those complications.
In the retrospective cohort study, published in JAMA Surgery, investigators examined the outcomes of 863,305 Medicare beneficiaries who underwent high-risk vascular or cardiac surgeries between 2015 and 2020.
After adjusting for factors such as age, comorbidities, and hospital characteristics, the investigators reported that female patients had a 25% higher risk of failure to rescue—death following a serious postoperative complication—compared with male patients (adjusted relative risk [RR] = 1.25, 95% confidence interval [CI] = 1.22–1.28, P < .001). This pattern was consistent across all procedure types examined.
The investigators also found that female patients had slightly higher rates of serious complications compared with male patients (14.98% vs 14.37%, adjusted RR = 1.04, 95% CI = 1.03–1.05, P < .001). The 30-day mortality rate was 4.22% among female patients compared with 3.34% among male patients (adjusted RR = 1.26, 95% CI = 1.23–1.29, P < .001).
The study included procedures such as coronary artery bypass grafting, abdominal aortic aneurysm repair, aortic valve replacement, and mitral valve replacement or repair. The investigators used Medicare claims data and adjusted for various patient and hospital factors in their analysis.
Female patients in the study cohort were more likely to receive care at large, high-volume teaching hospitals. The disparity in outcomes persisted even after controlling for hospital factors.
The investigators emphasized that their study built on previous research examining sex-based differences in surgical outcomes. They suggested that improved recognition and management of complications in female patients could potentially help address the observed disparity in mortality.
The study acknowledged limitations, including the lack of clinical granularity in administrative claims data. However, the large, nationally representative sample provided data on sex-based differences in outcomes for high-risk surgical procedures among Medicare beneficiaries.
Conflict of interest disclosures can be found in the study.