Abstract 1937: Sex Differences in Mortality After Cardiac Surgery in Children With Congenital Heart Disease: A US Population Based Study
Background: Sex differences in outcomes for cardiovascular disease are well described in adults, but there is a paucity of data in children with congenital heart disease (CHD). We sought to investigate sex differences in a large US population-based hospitalization database.
Methods: Children < 18 years old hospitalized for CHD surgery were identified using the Kids’ Inpatient Database in years 2000, 2003 and 2006. This includes 80% of all children hospitalized in up to 38 US states. Using demographic, diagnostic and procedural variables hospitalizations were grouped into risk categories with RACHS methodology (1 to 6 from lowest to highest risk). We used logistic regression models to compare mortality odds in females vs. males before and after adjustment for confounders (age, risk group, major non-cardiac anomalies and multiple procedures). Analyses were performed in sub-groups defined by age and risk category.
Results: Of 33,848 hospitalizations for CHD surgeries, 54.7% were in males. Males were more likely than females to have CHD surgery in infancy (57.5 vs. 55.4%, p <0.0001), high risk CHD surgery (RACHS >4: 14.3 vs. 12.0%, p <0.0001) and multiple CHD procedures (19.7 vs 18.5%, p = 0.005), while females had more major non-cardiac structural anomalies (4.5% vs. 3.8%, p = 0.001). The adjusted risk of in-hospital death was significantly higher in females (OR 1.17, 95% CI 1.04 –1.31) on account of the subgroup with high risk surgeries who were less than one year of age (OR 1.39, 1.16 –1.67)(Figure⇓).
Conclusions: In a large US population-based sample, although more male children undergo CHD surgery, female infants had increased mortality for high-risk procedures.