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J Thorac Cardiovasc Surg 2007;133:668-675
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Female gender increases the risk of death during hospitalization for pediatric cardiac surgery

^a Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia, Philadelphia, Pa
^b Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pa
^c School of Medicine, Johns Hopkins University, Baltimore, Md
^d Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pa
^e Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pa.

Received for publication September 14, 2006; revisions received October 21, 2006; accepted for publication November 1, 2006.

^_* Address for reprints: Harry A. Seifert, MD, MSCE, Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104 (Email: harryaseifert{at}comcast.net).

Objectives: The study objective was to determine whether gender is a determinant of in-hospital mortality after surgery to repair congenital heart disease in patients aged 20 years or less. Secondary objectives were to determine other factors associated with increased risk of death and whether female gender is associated with increased length of stay or total charges.

Methods: The study included a retrospective cohort consisting of all records indicating cardiac operations within the Healthcare Cost and Utilization Project Kids’ Inpatient Database for the year 2000. Logistic regression was used to simultaneously evaluate the effect of gender on the risk of death while adjusting for all other factors being considered. Logistic regression was then used to evaluate possible differences in length of stay or total charges.

Results: Female gender was associated with increased risk of in-hospital death when all of the other measured factors were taken into consideration (odds ratio 1.31, 95% confidence interval 1.02-1.69). Other factors that were significantly associated with increased in-hospital mortality after pediatric cardiac surgery included the number of days between admission and operation; African American race; young age (neonates and infants compared with children aged 1 year); pulmonary hypertension; and the Norwood operation. There were no significant gender differences in risk-adjusted length of stay or total charges.

Conclusions: In-hospital mortality after pediatric cardiac surgery seems to be associated with patient gender but not with the type of insurance or ability to access higher-volume pediatric facilities or teaching hospitals.

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