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The role of preoperative hematocrit and body surface area in the gender gap seen in cardiac surgery outcomes : a thesis submitted to the faculty of the Milwaukee School of Engineering in partial fulfillment of the requirements for the degree of Master of Science in Perfusion / by Samantha M. Martin.

by Martin, Samantha M. author , Milwaukee School of Engineering

Cardiopulmonary bypass -- Adverse effects

Heart Diseases -- women.

87 leaves : illustrations, some of which are in color ; 29 cm.

Thesis advisor: Dr. Ronald Gerrits.

Committee members: Dr. Larry Fennigkoh, Kirsten Kallies.

Introduction -- Background -- Materials and methods -- Results -- Discussion -- Conclusion -- Recommendations for future studies -- References -- Appendix A: Chi-Square statistics -- B: Unaired T-Tests -- C: Regression analyses -- D: Logistic regression analyses.

Since the 1970s, research has shown that men have better outcomes than women after cardiac surgery. This difference between sexes is termed the "gender gap" and determining the source of this gap could lead to changes in treatments that could maximize outcomes for men and women. One possible reason that this gap may occur in cardiac surgery outcomes is the use of cardiopulmonary bypass (CPB). This may be because the hemodilution associated with going "on-pump", in conjunction with the lower average pre-surgical hematocrit and body size of women, leads to lower intraoperative hematocrit. Decreased hematocrit is itself a risk factor for receiving blood products, which may contribute to the difference in outcomes.

The current study is aimed at determining if a gender gap exists in surgical outcomes from a single cardiac surgeon at Aurora St. Luke's Hospital, and if so, if the difference would be associated with decreased pre-operative hematocrit and smaller body surface area (BSA) as compared to men. A retrospective analysis of 101 patients was performed that looked at the correlation of pre-operative hematocrit, BSA, age, gender, CPB time, cross-clamp time, incidence of comorbidities, and the use of antifibrinolytics with clinical outcomes. These outcomes included intubation time, length of ICU stay, length of total stay, post-operative mortality and the occurrence of complications including arrhythmias, renal dysfunction, infection, stroke, bleeding, and use of intra-aortic balloon pump. T-tests and Chi-Square tests were performed to compare pre- and intra-operative conditions of males and females, as well as their outcomes. Logistic, general, and multiple regressions were done to compare significant predictors of male, female, and overall outcomes.

Of all the pre- and intra-operative variables recorded only two differed between genders; males had higher pre-operative hematocrit and larger BSA compared to females. Analysis of post-operative data revealed no difference between males and females in any of the outcomes recorded. However, regression analysis did suggest that significant predictors for intubation time, length of ICU stay, total length of stay, and arrhythmias may differ between sexes.

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