intraoperative anemia<\/a> in CABG and identified it as a key mediator.<\/p>\nDiscordance Not a Driver<\/p>\n
The researchers analyzed data from 223,065 Medicare beneficiaries (68.2% male) who underwent coronary artery bypass grafting, surgical aortic valve replacement, and\/or proximal aortic surgery from 2010 to 2021. Stratified by sex, 59.9% of the cases involved a patient and surgeon who were both male, 28.0% a female patient with a male surgeon, 8.3% a male patient with a female surgeon, and 3.8% a female patient and surgeon.<\/p>\n
At 30 days, the mortality rate was 4.1%, while the rate of mortality plus morbidity (MI, stroke, and all-cause readmission) was 30.1%. There was no difference in the composite between men who were treated by a male versus female surgeon (27.6% vs 27.4%) or between women who were treated by a male versus female surgeon (35.5% vs 35.1%). Although there was an imbalance between the concordant and discordant groups (28.0% vs 33.6%; P < 0.001), on multivariable regression analysis the patient\/surgeon mismatch was not independently associated with outcomes (OR 1.00; 95% CI 0.96-1.04). There also was no interaction between patient sex and sex discordance for outcomes (P = 0.75).<\/p>\n
At 5 years, the morbidity and mortality rate was higher for male patients treated by a man (67.2%) than those treated by a woman (65.3%; P < 0.001). Among female patients, it was higher for those treated by a man compared with by a woman (75.7% vs 74.0%; P = 0.0006). Again, though, discordance was not independently associated with outcome (HR 1.00; 95% CI 0.98-1.02) and there was no interaction between patient sex and discordance (P= 0.89).<\/p>\n
I think of [our study] as a starting point and not an ending point. Lamia Harik<\/p>\n
Harik said a limitation of their study is that some Medicare beneficiaries did not have their surgeon\u2019s sex recorded in the database. Additionally, the number of women with female surgeons was quite small. \u201cI wouldn\u2019t say that our retrospective study is the final word on the topic. I think of it as a starting point and not an ending point,\u201d she stressed. Additionally, it speaks to \u201cthe need to have more female providers in cardiac surgery.\u201d<\/p>\n
Gaudino, for his part, noted that while their analysis didn\u2019t confirm their initial hypothesis that sex concordance affected outcomes in this setting, it wasn\u2019t done in vain. \u201c\u200aThe process of eliminating hypotheses that are not true is actually very important,\u201d he said.<\/p>\n
Going forward, it will be important for cardiac surgery databases to collect more information on the surgeons themselves so that it\u2019s possible to dig into any patterns that emerge, Harik and Gaudino both stressed.<\/p>\n
The current study, Gaudino said, \u201crepresents an interesting change in the focus of outcomes research from the patient to the provider.\u201d An example of this is the potential relevance of group dynamics, such as how different surgeons and anesthesiologists interact.<\/p>\n
Notably, the ROMA-Women trial<\/a>, the first in cardiac surgery to be devoted entirely to women, is collecting details on providers, Harik said. \u201c\u200aWe\u2019re collecting the kind of data that we don\u2019t see available in current databases for our prospective randomized study.\u201d<\/p>\nGaudino urged that a key way to improve female patients\u2019 outcomes in cardiac surgery is to have more female clinicians and investigators involved in research. \u201cUnfortunately, there\u2019s no doubt that one of the reasons why we have such limited information on cardiac surgery in women is because so far most cardiac surgeons have been men and research . . . has been mostly done by men,\u201d he commented, predicting that the younger generation of cardiac surgeons, increasingly more of them female, will be better equipped to pinpoint what\u2019s driving sex disparities.<\/p>\n","protected":false},"excerpt":{"rendered":"The search for the reason why women have worse surgical outcomes than men continues. Sex discordance isn\u2019t an…\n","protected":false},"author":2,"featured_media":410239,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[103,61,60],"class_list":{"0":"post-410238","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-health","9":"tag-ie","10":"tag-ireland"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/410238","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=410238"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/410238\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/410239"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=410238"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=410238"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=410238"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}