BACKGROUND: 

Cardiac valvular disease affects millions of people worldwide and is a major cause of morbidity and mortality. Female patients have been shown to experience inferior clinical outcomes after nonvalvular cardiac surgery, but recent data are limited regarding open valve surgical cohorts. The primary objective of our study was to assess whether female sex is associated with increased in-hospital mortality after open cardiac valve operations.

METHODS: 

Utilizing the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), we conducted a retrospective cohort study of patients who underwent open cardiac valve surgery from 2007 to 2018 in Washington, Maryland, Kentucky, and Florida; from 2007 to 2011 in California; and from 2007 to 2016 in New York. The primary objective of this study was to estimate the confounder-adjusted association between sex and in-hospital mortality (as recorded and coded by SID HCUP) after open cardiac valve surgery. We used multilevel multivariable models to account for potential confounders, including intrahospital practice patterns.

RESULTS: 

A total of 272,954 patients (108,443 women; 39.73% of sample population with mean age of 67.6 ± 14.3 years) were included in our analysis. The overall mortality rates were 3.8% for male patients and 5.1% for female patients. The confounder-adjusted odds ratio (OR) for in-hospital mortality for female patients compared to male patients was 1.41 (95% confidence interval [CI], 1.35–1.47; P < .001). When stratifying by surgical type, female patients were also at increased odds of in-hospital mortality (P < .001) in populations undergoing aortic valve replacement (adjusted OR [aOR], 1.38; 95% CI, 1.25–1.52); multiple valve surgery (aOR, 1.38; 95% CI, 1.22–1.57); mitral valve replacement (aOR, 1.22; 95% CI, 1.12–1.34); and valve surgery with coronary artery bypass grafting (aOR, 1.64; 95% CI, 1.54–1.74; all P < .001). Female patients did not have increased odds of in-hospital mortality in populations undergoing mitral valve repair (aOR, 1.26; 95% CI, 0.98–1.64; P = .075); aortic valve repair (aOR, 0.87; 95% CI, 0.67–1.14; P = .32); or any other single valve repair (aOR, 1.10; 95% CI, 0.82–1.46; P = .53).

CONCLUSIONS: 

We found an association between female patients and increased confounder-adjusted odds of in-hospital mortality after open cardiac valve surgery. More research is needed to better understand and categorize these important outcome differences. Future research should include observational analysis containing granular and complete patient- and surgery-specific data.

中文翻译：

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开放式心脏瓣膜手术后住院死亡率的性别差异

背景： 

心脏瓣膜病影响全世界数百万人，是发病和死亡的主要原因。已显示女性患者在非瓣膜心脏手术后的临床结果较差，但最近关于开放瓣膜手术队列的数据有限。我们研究的主要目的是评估女性是否与心脏瓣膜开放手术后住院死亡率增加有关。

方法： 

利用医疗保健成本和利用项目 (HCUP) 州住院患者数据库 (SID)，我们对 2007 年至 2018 年在华盛顿、马里兰州、肯塔基州和佛罗里达州接受开放心脏瓣膜手术的患者进行了一项回顾性队列研究；从 2007 年到 2011 年在加利福尼亚；从 2007 年到 2016 年在纽约。本研究的主要目的是估计开放心脏瓣膜手术后性别与住院死亡率（由 SID HCUP 记录和编码）之间的混杂因素调整关联。我们使用多级多变量模型来解释潜在的混杂因素，包括院内实践模式。

结果： 

我们的分析共纳入 272,954 名患者（108,443 名女性；占样本人群的 39.73%，平均年龄为 67.6 ± 14.3 岁）。男性患者的总死亡率为 3.8%，女性患者为 5.1%。与男性患者相比，女性患者住院死亡率的混杂因素调整优势比 (OR) 为 1.41（95% 置信区间 [CI]，1.35-1.47；P < .001）。当按手术类型分层时，女性患者在接受主动脉瓣置换术的人群中住院死亡率的几率也增加了（P < .001）（调整后的 OR [aOR]，1.38；95% CI，1.25-1.52）；多瓣膜手术（aOR，1.38；95% CI，1.22–1.57）；二尖瓣置换术（aOR，1.22；95% CI，1.12 –1.34); 冠状动脉旁路移植术和瓣膜手术（aOR，1.64；95% CI，1.54 – 1.74；所有P < .001）。在接受二尖瓣修复术的人群中，女性患者的院内死亡率没有增加（aOR，1.26；95% CI，0.98 – 1.64；P = .075）；主动脉瓣修复（aOR，0.87；95% CI，0.67 – 1.14；P = .32）；或任何其他单瓣修复（aOR，1.10；95% CI，0.82 – 1.46；P = .53）。

结论： 

我们发现女性患者与开放心脏瓣膜手术后经混杂因素调整的住院死亡率增加之间存在关联。需要更多的研究来更好地理解和分类这些重要的结果差异。未来的研究应包括观察性分析，其中包含详细且完整的患者和手术特定数据。