gms | German Medical Science

Introduction: The impact of gender in elderly patients on outcome after cardiac surgery is still controversial. Objective of this study was to evaluate the hypothesis that females have a worse outcome compared to males after cardiac surgery.

Materials and methods: Between January 2006 and August 2009, a total of 598 patients (274 female, 324 male) between 70 and 89 years (299 septuagenarians, 299 octogenarians) were retrospectively reviewed. Primary endpoint was in-hospital and 30-day mortality, whereas postoperative morbidity was considered as secondary endpoint.

Results: Mean age was insignificant between men and women (77.8 ± 4.8 vs. 78.3 ± 4.8 years; p=0.23). They were equally subdivided in septuagenarians and octogenarians with 137 females and 162 males within each group. Mean logistic EuroSCORE was 11.9% in females and 9.9% in males (p= 0.007). Operations included 246 coronary, 198 isolated valve and 154 combined coronary and valve procedures. Operations were elective in 164 (59.9%) female patients and in 169 (52.3%) male patients (p= 0.148). Women had more often diabetes mellitus (12.4% vs. 7.4%; p=0.05) and significantly more frequent an estimated GFR < 60 mL/min/1.73m² (51.5% vs. 28.6%; p<0.001). Overall in-hospital (7.3% vs. 5.6%; p=0.40) and 30-day mortality (8% vs. 5.9%; p=0.33) were not significantly higher in females. Additionally, there were no significant differences in mortality with respect to each age group. Postoperative morbidity including stroke (p= 0.41), acute kidney failure (p= 0.49) and respiratory insufficiency (p= 1.00) was indifferent between both gender groups similarly to length of intensive care (p=0.68) and hospital stay (p=0.52).

Conclusion: In elderly patients, female gender is not associated with increased morbidity and mortality after cardiac surgery. They can be operated on at an acceptable risk and should not be denied the benefits of surgery. Further adjustment of risk stratification is needed.