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Sex-Based Outcomes of Surgical Myectomy for Hypertrophic Cardiomyopathy: An Analysis t from The National Readmission Database

Published:November 24, 2021DOI:https://doi.org/10.1016/j.jtcvs.2021.11.043
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      Abstract:

      Background

      There is a paucity of data on sex differences in outcomes after surgical myectomy (SM) for hypertrophic cardiomyopathy (HCM).

      Methods

      Patients who received SM for HCM during October 1st, 2015-December 31st, 2018, were identified from the United States National Readmission Database. The primary endpoint of this study was in-hospital mortality. The secondary endpoints were major bleeding, acute kidney injury (AKI), new pacemaker implantation, severe disability surrogates (non-home discharge and need for mechanical ventilation), resources utilization surrogates (length of stay and cost of hospitalization), and 30-day outcomes (readmission rate, mortality, and new pacemaker insertion).

      Results

      A total of 3,031 patients were included in the current analysis. Using propensity score matching, two well-matched cohorts were compared (Females=1170 and Males=1127). Females had higher requirement for new pacemaker insertion compared to males (10.9% vs 6.8%, p=0.029), higher non-home discharges (13.8% vs 7.9%; p<0.01) and longer length of hospital stay (median=7 days [IQR 5-9]) vs. (median=6 days [IQR 5-8]). There was no difference in in-hospital mortality, major bleeding, blood transfusion, AKI, or hospitalization costs for females versus males. At 30-days, females continued to show a higher need for pacemaker insertion (11.3% vs. 7.1%, p=0.03) and had a higher readmission rate than males (10.9% vs. 7.1%, p=0.02). There was no difference in 30-day mortality between females and males (3% vs. 2.4%, p=0.54).

      Conclusions

      Among the HCM cohort who received SM, significant sex-based differences in the outcomes were observed. Females had higher new pacemaker insertion, higher non-home discharge, and higher 30-day readmission compared to males.

      Graphical abstract

      Key Words

      Glossary of Abbreviations:

      Acute Kidney Injury (AKI), Agency for Healthcare Research and Quality (AHRQ), Coronary Artery Bypass Grafting (CABG), Hypertrophic Cardiomyopathy (HCM), International Classification of Disease (ICD), Left Ventricular Outflow Tract Obstruction (LVOTO), National Readmission Database (NRD), PSM (Propensity Score Matching), Surgical Myectomy (SM)
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