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Children's Health

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Among children undergoing heart surgery, girls are far more likely than boys to die in the hospital

Girls are far more likely than boys to die in the hospital after undergoing surgery for congenital heart disease (CHD), according to a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00028). Ruey-Kang R. Chang, M.D., M.P.H., of the Harbor-UCLA Medical Center, and colleagues examined California hospital discharge data from 1995 to 1997 to identify children under 21 years of age who underwent one of 23 types of cardiac surgery for CHD and died in the hospital.

They controlled for age, race and ethnicity, type of insurance, home income, type of hospital admission, date and month of surgery, hospital case volume, and type of procedure to evaluate the effect of sex on in-hospital death. Overall, there were 6,593 cases of cardiac surgery for CHD, with 345 in-hospital deaths (mortality rate of 5.23 percent). Crude mortality rates (unadjusted for risk) for males (4.98 percent) and females (5.54 percent) were not significantly different. However, after controlling for all variables (other than sex) affecting mortality (for example, coexisting medical conditions and risks of various types of cardiac surgery), girls had a 51 percent higher odds of death than boys. The reasons for this disparity are unclear.

Neonates had mortality rates that were nearly four times as high (nearly three times as high for infants) as those of children 1 year or older. Nonelective surgeries carried a two-fold higher mortality rate than elective surgeries. Finally, high-volume hospitals (average annual case volume of more than 100) had significantly lower overall mortality rates than the low-volume (less than 100 cases per year) hospitals (5 vs. 5.74 percent). The sex difference in mortality after cardiac surgery was probably not due to variation in service use during hospitalization, since risk-adjusted hospital length of stay and hospital charges were similar for boys and girls. Race and ethnicity, type of insurance, and home income did not affect outcomes.

More details are in "Female sex as a risk factor for in-hospital mortality among children undergoing cardiac surgery," by Dr. Chang, Alex Y. Chen, M.D., and Thomas S. Klitzner, M.D., Ph.D., in the September 17, 2002, Circulation 106, pp. 1514-1522.

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