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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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

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


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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