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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2001 June;42(3):311-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Conventional coronary artery bypass grafting: why women take longer to recover

Ott R. A., Gutfinger D. E., Alimadadian H., Selvan A., Miller M., Tanner T., Hlapcich W. L., Gazzaniga A. B.

From the Cardiothoracic Services Anaheim Memorial Medical Center Anaheim, CA, USA


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Back­ground. ­Recovery fol­lowing suc­cessful cor­o­nary ­artery ­bypass ­grafting (­CABG) has ­been dra­mat­i­cally ­improved ­with the use of ­fast-­track ­methods. ­Although ­data ­exist ­that dem­on­strate a sig­nif­i­cant ­gender dif­fer­ence in sur­vival fol­lowing ­CABG, ­little is ­known ­about fac­tors influ­encing ­gender-spe­cific ­recovery. ­This ­report ­describes a ­series of con­sec­u­tive ­patients under­going iso­lated ­CABG to deter­mine ­gender-asso­ciated fac­tors ­that may ­impact out­comes and ­recovery.
­Methods. ­Five hun­dred and sev­en­teen con­sec­u­tive ­patients under­went iso­lated ­CABG util­izing car­di­o­pul­mo­nary ­bypass and ­were ret­ro­spec­tively ­reviewed. The out­comes of 351 men in the ­study ­were com­pared to the ­group of 160 ­women. A ­rapid ­recovery pro­tocol ­focused on ­reduced car­di­o­pul­mo­nary ­bypass ­time, aggres­sive pre­op­er­a­tive ­intra-­aortic bal­loon ­pump use, ­early extu­ba­tion, per­i­op­er­a­tive admin­is­tra­tion of cor­ti­cos­ter­oids and thy­roid hor­mone, aggres­sive diu­resis and ­atrial fib­ril­la­tion pre­ven­tion was ­applied to all ­patients.
­Results. The 30-day mor­tality ­rate for the ­women was 4.2% (Par­sonnet ­risk 16.3±9.0) com­pared ­with 3.4% (Par­sonnet ­risk 9.9±7.5) for the men. ­There ­were no sta­tis­ti­cally sig­nif­i­cant dif­fer­ences in the 30-day mor­tality ­rates or post­op­er­a­tive com­pli­ca­tion ­rates ­between the ­women and men. The ­women, how­ever, ­were ­found to be ­older (71± ­years ­versus 65± ­years, p<0.001), and to ­have a ­higher inci­dence of ­acute myo­car­dial infarc­tion (31% ­versus 20%, p<0.05), ­obesity (23% ­versus 10%, p <0.05), dia­betes (31% ­versus 22%, p<0.05), hyper­ten­sion (65% ­versus 48%, p<0.001), and symp­to­matic vas­cular dis­ease (20% ­versus 12%, p<0.05). The ­women ­required ­fewer ­bypass ­grafts (2.9 ­versus 3.5 ­grafts, p<0.001), and con­se­quently, had ­shorter ­cross and car­di­o­pul­mo­nary ­bypass ­times. ­Rapid ­recovery ­with dis­charge ­before the ­fifth post­op­er­a­tive day was ­achieved in 30% of the ­women, in com­par­ison to 44% of the men (p<0.01). The post­op­er­a­tive hos­pital ­length of ­stay was ­longer for the ­women in com­par­ison to the men (7.2±7.1 ­versus 5.8±5.2 ­days, p<0.05).
Con­clu­sions. ­Women had sim­ilar oper­a­tive mor­tality and post­op­er­a­tive com­pli­ca­tion ­rates to men ­under a ­rapid ­recovery pro­tocol. How­ever, ­women ­have a ­longer ­recovery ­interval com­pared to men, ­which may be a reflec­tion of ­their ­higher pre­op­er­a­tive ­risk pro­file.

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