'Red flag': Women more likely than men to die from complications after heart surgery

Women are more likely than men to die from complications related to high-risk cardiovascular surgery, a new study suggests.

These life-threatening complications, such as heart attacks and infections, were more likely to be detected too late in women than in men, leading to a higher mortality rate among women. Failing to recognize or respond to complications quickly enough is calledfailed rescue“by doctors.

The new study, published October 16 in the journal JAMAanalyzed the medical records of more than 860,000 patients who underwent high-risk surgical procedures between October 2015 and February 2020. All procedures involved the heart or blood vessels, including surgical procedures to repair aneurysmsheart bypasses and heart valve replacements.

Overall, approximately 15% of these patients experienced complications following their procedure; a similar rate of complications was observed in men and women. But, across the group as a whole, nearly 11% of women died from complications, compared to 8.6% of men. The researchers concluded that this difference was likely caused by delays in doctors’ recognition and treatment of complications in women, including heart attacksblood clots in the lungs, kidney failure, lung failure, pneumonia, hemorrhage, and surgical site infections.

Dr Mario Gaudinoa heart surgeon at Weill Cornell Medical Center and New York Presbyterian Hospital who was not involved in the research, described the study as a “wake-up call” about long-neglected disparities in men’s outcomes and women after major surgeries.

Notably, women participating in the study were also more likely to receive care at university hospitals and bigger, high volume hospitalscompared to men. These types of facilities are associated with higher quality care than other medical centers, such as low-volume hospitals. However, the higher mortality rate of women was consistent across all different facilities.

“On the contrary, these results show how pervasive the problem is,” said Dr Catherine Wagnerresident in cardiac surgery at the University of Michigan and lead author of the study. “This suggests that there is a systemic problem contributing to the underrecognition and undertreatment of women’s postoperative complications,” Wagner said in an email to Live Science.

The study does not draw any definitive conclusions about what factors might be causing this disparity. Previous research has focused on the tendency of women to have surgery at a later age than men, meaning they may face more underlying medical issues and be at a more advanced stage of the disease. disease. These characteristics were reflected in women in the new study, who, on average, were slightly older and had a slightly higher rate of comorbidities than men.

However, while these are relevant factors, they fail to fully explain the study results, which reveal a much higher mortality rate among women, even though both men and women have lower rates. and similar types of complications, said Dr. Andrei Churyla, a heart surgeon at Northwestern Medical Group in Chicago who was not involved in the study.

Unconscious bias against women could be a possible explanation, he said. Medical providers tend to ignore women’s pain, which can delay or even prevent proper diagnosis and treatment. A 2022 study in the Journal of the American Heart Association found that young women who complained of chest pain had a 29% longer wait time for a heart attack evaluation than young men, for example.

A lack of understanding of the female heart may also impact patient outcomes, Gaudino suggested. “As cardiovascular doctors, I think we’ve had the wrong approach in thinking that women are actually like men, or just short men,” he said. “The mistake we are making is continuing to treat women with approaches that we know work for men.”

Until recently, much of the research in cardiac surgery has focused on predominantly male populationsand few studies have been conducted specifically on female patients, Gaudino said.

Additionally, the diagnostic criteria for complications were developed based on data from male patients. They may therefore overlook differences in women’s basic physiology and how these complications manifest in them. As an example, high levels of troponin, a protein found in heart muscles, signal that a heart attack is imminent – but the threshold for what is considered “high” comes primarily from men, who have higher baseline troponin levels than women, he said.

Gaudino suspects that the female body is still poorly understood by doctors and that this means that complications that would be easily reported in male patients are more likely to go unnoticed, and therefore untreated, in female patients. .

Efforts have recently been made to strengthen research in this area to better understand and close the gap in surgical outcomes between men and women.

“I think we have to constantly remind ourselves that women are different from men,” said Dr Bretagne Zwischenbergercardiac surgeon at Duke Health in Durham, North Carolina. “And our current focus on sex and gender will hopefully lead to tailored approaches to surgery and its postoperative course, and ultimately reduce disparities. But in reality, this (study) is an opportunity for us to improve postoperative care for all patients.”

This article is for informational purposes only and is not intended to offer medical advice.

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‘Red flag’: Women more likely than men to die from complications after heart surgery

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