A recent study led by the University of Michigan indicates that women, though not more likely to face problems post high-risk cardiovascular surgery, are more susceptible to fatal complications compared to men.
The term “failure to rescue” refers to cases where patients suffer fatal complications after surgery.
The researchers analyzed over 850,000 instances of Medicare patients undergoing high-risk heart surgeries—including procedures like heart bypass, aortic aneurysm repair, and mitral and aortic valve repairs—between 2015 and 2020.
Both genders experienced complications at similar rates, approximately 15% following surgery.
However, the mortality rate from these complications was significantly higher in women: surgical teams failed to save female patients 10.7% of the time, compared to only 8.6% for male patients.
The findings are detailed in JAMA Surgery.
“This issue affects the entire U.S. healthcare system: we see that women are not being adequately rescued after high-risk surgeries, despite experiencing a similar rate of postoperative complications as men,” stated Catherine M. Wagner, M.D., M.Sc., the study’s lead author and a thoracic surgery resident at University of Michigan Health.
“We need to better recognize and respond to complications to help reduce the existing disparities between sexes after such surgeries.”
The research revealed a consistent failure-to-rescue pattern across different types of procedures.
The most frequent complications for both men and women included kidney failure, pneumonia, and lung failure.
The quality of the hospital where the surgery was performed did not influence the differences observed between men and women regarding rescue failure.
Interestingly, women in the study were more likely to undergo surgeries in hospitals that typically handle a larger number of high-risk procedures.
“While these high-risk operations are expected to have better complication outcomes, patients should have positive results when complications are managed effectively and efficiently,” explained co-author Gorav Ailawadi, M.D., M.B.A., chair of cardiac surgery at U-M Health and director of the University of Michigan Health Frankel Cardiovascular Center.
“Our study found that female patients had a lower incidence of reoperations compared to males,” he noted, referring to the need for a second procedure shortly after the first.
“This could indicate a lack of appropriate management of their complications rather than a lower necessity for reoperation.”
Research has consistently shown that women are at higher risk of mortality following cardiovascular surgeries.
This issue has often been attributed to the fact that women tend to be older and have more health issues than men prior to surgery.
Women’s smaller body size and vessel dimensions can also make surgical procedures more challenging.
Moreover, there is existing research that highlights how symptoms of common conditions like heart attacks and strokes are frequently overlooked or dismissed in female patients.
“After considering the health issues and risks of the patients, we found that both men and women experienced similar types and rates of complications; however, women remained at a greater risk of death from these complications,” mentioned co-author Andrew Ibrahim, M.D., M.Sc., an associate professor of surgery at U-M Medical School and a co-director of the Michigan Medicine Center for Healthcare Outcomes and Policy.
“Beyond simply reducing complications overall, it is crucial to focus on the outcomes following a complication. We need to enhance our recognition of when female patients are experiencing complications, intervening early before it becomes critical. Improving our response to postoperative issues, particularly for women, is essential to address these long-standing disparities in surgical outcomes.”
Historically, women have been underrepresented in medical studies.
In June 2016, the National Institutes of Health implemented a policy emphasizing the need to incorporate sex as a biological variable in research design, analysis, and reporting.
“While we take measures at the health system level to correct this disparity, it is equally important to continue exploring sex differences in biomedical research to rectify the longstanding oversight in women’s health and to uncover the fundamental factors that can, when addressed, lead to better outcomes for all patients,” added Wagner.
