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1993-2003 Gender Differences in Coronary Artery Revascularization: Has Anything Changed?

Edwards, Michelle L. BSN, RN; Albert, Nancy M. PhD, CCNS, CCRN, CNA; Wang, Chaohui MS; Apperson-Hansen, Carolyn MStat

The Journal of Cardiovascular Nursing: November-December 2005 - Volume 20 - Issue 6 - p 461-467
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Background: Gender differences abound in patients undergoing coronary artery bypass graft (CABG) surgery. Most research was conducted in the early 1990s. It is unknown if gender differences have diminished over time.

Research objectives: To determine whether gender differences exist in the current era of CABG surgery by examining preoperative, intraoperative, and postoperative factors known to affect outcomes.

Subjects and methods: In this descriptive, correlational study of all patients undergoing primary, isolated CABG at a large, urban Midwestern healthcare center, data in 1993 and 2003 were analyzed to determine if gender and time differences existed and if there was a time and gender interaction effect. Trained nurses prospectively collected data during the index hospitalization for the institution's Cardiovascular Information Registry.

Results: 2,200 patients were studied; women accounted for one-fourth of the sample. Age over 65 years; current smoking; presence of hypertension, cerebrovascular accident; and insulin-dependent diabetes; symptomatic heart failure and chest pain were significantly associated with female gender (all P's < .001). Intraoperatively, internal mammary arteries were used less as a graft conduit in women (P < .001); gender differences were most pronounced in patients requiring 2 bypass grafts. Postoperatively, cardiac pump failure and median hospital stay were greater in women (both P's < .001); however, both decreased over time.

Conclusions: Gender differences continue to exist in patients undergoing CABG. Differences do not affect hospital mortality rates but play a role in hospital length of stay and may affect postdischarge recovery. Research targeted at modifiable preoperative factors may improve postoperative recovery.

Michelle L. Edwards, BSN, RN Manager of Registry Operations, Clinical Investigations Unit, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.

Nancy M. Albert, PhD, CCNS, CCRN, CNA Director of Nursing Research, Division of Nursing and Clinical Nurse Specialist, Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio.

Chaohui Wang, MS Statistical Programmer, Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio.

Carolyn Apperson-Hansen, MStat Research Associate, Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio.

Corresponding author Nancy M. Albert, PhD, RN, CCNS, CCRN, CNA, The Cleveland Clinic Foundation, 9500 Euclid Avenue, M-13, Cleveland, OH 44195 (e-mail: albertn@ccf.org).

© 2005 Lippincott Williams & Wilkins, Inc.