Abstract 8969: Female Sex Is Associated With Increased Mortality After Pediatric Cardiac Surgery
Surgical mortality for congenital heart defects is affected by several center and patient specific factors. The role of patient's sex as risk factor for death after pediatric cardiac surgery is disputed. We used 1982-2007 outcome data from the Pediatric Cardiac Care Consortium, a large multi-center clinical database to examine whether sex represents a prognostic factor for mortality after pediatric cardiac surgery. Hierarchical multivariate logistic regression analysis was used to determine the odds ratio (OR) of death for females vs. males after cardiac surgery in children (<18 years old) adjusting for RACHS-1 risk category, patient's age and weight at operation (neonates and infants < 2.5 kg, neonates > 2.5 kg, infants > 2.5 kg, children 1-5y, 6-12y, 13-18y), and 5-year time period of operation. Kaplan-Meier survival curves were generated to examine survival between females and males. After excluding cases without defined risk category or from years with incomplete data, 70,595 patients with 85,023 operations (53.9% males) were included in the analysis. The unadjusted OR for death between females and males was not statistically significant (OR 0.98, 95% CI 0.92-1.04). Males were more likely than females to have cardiac surgery of higher severity and as a neonate, both associated with higher risk of postsurgical mortality. After adjustment, female sex was associated with higher odds ratio (OR) of postoperative death (OR 1.18; 95% CI: 1.11-1.26, p<0.0001). The sex effect was restricted to neonates (OR 1.29, 95% CI 1.15-1.45, p<0.0001) and adolescents (OR 1.6, 95% CI 1.04-2.47, p=0.0342), and to more complex operations (risk categories 4-6 vs. 1-3 OR 1.28, 95% CI 1.14-1.43, p<0.0001). Kaplan-Meier survival curves after surgery demonstrated that the major separation between the survival curves occurs within one day of the operation and the survival curves are approximately parallel after the first day.
Conclusions: Female sex is associated with increased risk of early mortality after pediatric cardiac surgery. The risk is age- and risk category-specific affecting mostly neonates and adolescents undergoing higher risk procedures likely to require prolonged exposure to cardiopulmonary bypass.
- © 2011 by American Heart Association, Inc.