Sex differences in neurological outcomes and mortality after cardiac surgery - A society of thoracic surgery national database report

Background-The purpose of this study was to evaluate whether women undergoi ng cardiac surgery are more likely to suffer neurological complications tha n men and whether these complications could explain, at least in part, thei r higher perioperative mortality. Methods and Results-The Society of Thoracic Surgery National Cardiac Surger y Database was examined for the years 1996 and 1997 to determine the freque ncy of new neurological events (stroke, transient ischemic attack, or coma) occurring after cardiac surgery. We reviewed clinical information on 416 3 47 patients (32% women) for whom complete neurological outcome data were av ailable. New neurological events after surgery were higher for women than f or men (3.8% versus 2.4%, P=0.001). For the whole group, the 30-day mortali ty was higher for women than for men (5.7% versus 3.5%, P=0.001), and among those patients who suffered a perioperative neurological event, mortality was also significantly higher for women than men (32% versus 28%, P=0.001). After adjustment for other risk factors (eg, age, history of hypertension and/or diabetes, duration of cardiopulmonary bypass, and other comorbid con ditions) by multivariable logistic regression, female sex was independently associated with significantly higher risk of suffering new neurological ev ents after cardiac surgery (OR 1.21, 95% CI 1.14 to 1.28, P=0.001). Conclusions-Women undergoing cardiac surgery are more likely than men to su ffer new perioperative neurological events, and they have higher 30-day mor tality when these complications occur. The higher incidence of perioperativ e neurological complications in women cannot be explained by currently know n risk factors.