Conventional coronary artery bypass grafting: Why women take longer to recover

Background. Recovery following successful coronary artery bypass grafting ( CABG) has been dramatically unproved with the use of fast-track methods. Al though data exist that demonstrate a significant gender difference in survi val following CABG, little is known about factors influencing gender-specif ic recovery. This report describes a series of consecutive patients undergo ing isolated CABG to determine gender-associated factors that may impact ou tcomes and recovery. Methods. Five hundred and seventeen consecutive patients underwent isolated CABG utilizing cardiopulmonary bypass and were retrospectively reviewed. T he outcomes of 351 men in the study were compared to the group of 160 women . A rapid recovery protocol focused on reduced cardiopulmonary bypass time, aggressive preoperative intra-aortic balloon pump use, early extubation, p erioperative administration of corticosteroids and thyroid hormone, aggress ive diuresis and atrial fibrillation prevention was applied to all patients . Results. The 30-day mortality rate for the women was 4.2% (Parsonnet risk 1 6.3 +/- 9.0) compared with 3.4% (Parsonnet risk 9.9 +/- 7.5) for the men. T here were no statistically significant differences in the 30-day mortality rates or postoperative complication rates between the women and men. The wo men, however, were found to be older (71 years versus 65 years, p<0.001), a nd to have a higher incidence of acute myocardial infarction (31% versus 20 %, P<0.05), obesity (23% versus 10%, p <0.05), diabetes (31% versus 22%, p< 0.05), hypertension (65% versus 48%, p<0.001), and symptomatic vascular dis ease (20% versus 12%, P<0.05). The women required fewer bypass grafts (2.9 versus 3.5 grafts, p<0.001), and consequently, had shorter cross and cardio pulmonary bypass times. Rapid recovery with discharge before the fifth post operative day was achieved in 30% of the women, in comparison to 44% of the men (p<0.01). The postoperative hospital length of stay was longer for the women in comparison to the men (7.2 +/- 7.1 versus 5.8 +/- 5.2 days, P<0.0 5).