In-hospital CABG Mortality Has Improved Significantly in US Women

The outcome of coronary artery bypass grafting in women has improved markedly in the past 10 years, “despite a worsening case mix,” report Dr. Daniel J. O’Rourke of the VA Medical Center in White River Junction, Vermont and multicenter US colleagues in the February issue of the Annals of Thoracic Surgery.

The researchers collected data for 8029 women and 21,139 men who underwent CABG in northern New England between 1987 and 1997. They report that crude and adjusted mortality rates declined significantly over time for both men and women, but the magnitude of the change was greater for women than for men, at 3.1% vs 1.5%, respectively.

“Although women represented only 28% of the study population, the decrease in their mortality accounted for 44% of the total decrease in adjusted mortality,” the authors write. This was the case, despite the fact that women who underwent CABG between 1993 and 1997 were older, had poor ventricular function and more often required urgent or emergency surgery compared with women who underwent CABG between 1987 and 1989.

The improvement in CABG mortality for women is multifactorial, Dr. O’Rourke told Reuters Health. “Over the past decade, there have been a number of changes that likely contributed to this decline in mortality,” he said. “These include changes in surgical technique, such as increased use of left internal mammary artery grafting, and more attention to patient-specific characteristics, such as the patient’s heart rate just prior to undergoing surgery and their hemoglobin count.”

“Additionally, there was a region-wide improvement effort that was undertaken involving feedback of outcome data, training in continuous quality improvement techniques, and benchmarking,” Dr. O’Rourke added. “We feel that all of these factors played a role in the improvement in outcome.”

Ann Thorac Surg 2001;71:507-511