Background: Sex-based disparities in coronary artery bypass grafting (CABG) persist despite improvements in cardiothoracic surgery. A review of approximately 1.3 million CABG procedures performed in the US between 2011 and 2020 found that operative mortality was higher among females compared to males (2.8% vs. 1.7%), as was the occurrence of major complications in the postoperative period (22.9% vs. 16.7%) [1]. Females are also found to be at a disadvantage in the use of guideline-based multi-arterial and complete revascularization strategies. Objective To synthesize evidence on sex-based differences in CABG outcomes, including operative mortality, graft failure, and use of multi-arterial grafting, and to evaluate potential mediated factors such as intraoperative anemia and disparities in practice patterns.
Methods: This narrative review integrates findings from retrospective studies, Society of Thoracic Surgeons Adult Cardiac Surgery Database, and published meta-analyses of studies. Studies were identified through review of major registry reports and peer-reviewed literature evaluating sex-based CABG outcomes and were selected for relevance to sex-stratified CABG outcomes. The odds ratio for operative mortality and graft failure was assessed in females compared to males.
Results: Female gender was found to be independently associated with increased operative mortality with an adjusted ratio (aOR) of 1.28–1.41 [1]. A pooled analysis found a ratio of approximately 1.77 for mortality in females after undergoing CABG [2]. Females were found to be 14–22% less likely to receive multi-arterial grafting strategies [3]. Graft failure at one year was higher in females (37.3% vs. 32.9%) [4]. A significant proportion of mortality risk in females was mediated through intraoperative anemia [4].
Conclusion: Females undergoing CABG procedures have worse short-term outcomes. These sex-based disparities are a result of biological and systematic factors. The use of sex-based risk assessment tools and revascularization strategies is crucial in reducing preventable mortality and morbidity.
Methods: This narrative review integrates findings from retrospective studies, Society of Thoracic Surgeons Adult Cardiac Surgery Database, and published meta-analyses of studies. Studies were identified through review of major registry reports and peer-reviewed literature evaluating sex-based CABG outcomes and were selected for relevance to sex-stratified CABG outcomes. The odds ratio for operative mortality and graft failure was assessed in females compared to males.
Results: Female gender was found to be independently associated with increased operative mortality with an adjusted ratio (aOR) of 1.28–1.41 [1]. A pooled analysis found a ratio of approximately 1.77 for mortality in females after undergoing CABG [2]. Females were found to be 14–22% less likely to receive multi-arterial grafting strategies [3]. Graft failure at one year was higher in females (37.3% vs. 32.9%) [4]. A significant proportion of mortality risk in females was mediated through intraoperative anemia [4].
Conclusion: Females undergoing CABG procedures have worse short-term outcomes. These sex-based disparities are a result of biological and systematic factors. The use of sex-based risk assessment tools and revascularization strategies is crucial in reducing preventable mortality and morbidity.