Scott E. Woods

The influence of gender in patients undergoing coronary artery bypass graft surgery: an eight-year prospective hospitalized cohort study

BACKGROUND We prospectively assess if there are any outcome differences between men and women undergoing coronary artery bypass graft surgery. STUDY DESIGN This is an eight-year, prospective, hospitalization cohort study. Data were collected on 225 variables concurrently with admission. The main outcome was mortality. In addition, we evaluated 12 morbidity outcomes. To minimize confounding, we controlled for 18 other variables. RESULTS We analyzed 5,324 patients (1,742 women; 3,582 men). Women were significantly older, with more African Americans and more Medicaid-insured (p < 0.05). Men had significantly higher body surface area, creatinine, tobacco history, prior myocardial infarctions, left ventricular hypertrophy, and cardiac pump time (p < 0.05). Women had significantly more diabetes, hypercholesterolemia, hypertension, previous cerebrovascular disease, urgency of the surgical procedure, fewer arterial grafts, and reduced functional capacity by the New York Heart Association classification (p < 0.05). Using multiple regression analysis there was no difference for mortality, positive bacterial cultures, ICU length of stay, arrhythmias, reoperation for bleeding, pulmonary complications, gastrointestinal complications, and return to the ICU. Women had significantly more intraoperative complications (RR = 2.09, 95% CI 1.35-3.23), length of stay (RR = 1.01, 95% CI 1.002-1.027), and low cardiac output conditions (RR = 1.10, 95% CI 1.01-1.20). Males developed more neurologic complications (RR = 0.85, 95% CI 0.75-0.95). CONCLUSIONS Women undergoing coronary artery bypass graft surgery have more comorbidities at surgical presentation compared with men. Women have more unadjusted mortality, which is confounded by the difference in age and body surface area. But, even after multiple adjustments, female gender is a predictor of higher morbidity in patients undergoing coronary artery bypass graft.

Young adults admitted for asthma: Does gender influence outcomes?

OBJECTIVE To assess any outcome differences between young men and women who are admitted for asthma. METHODS We conducted a retrospective cohort study based on hospitalizations. An inclusion criterion was admission for asthma between January 1, 1998 and July 1, 2001. Exclusion criteria included age >45, chronic obstructive pulmonary disease (COPD), and emphysema. Data were collected on 10 potential confounding variables. Four outcome variables were assessed, including length of stay, intensive care unit (ICU) length of stay, mortality, and respiratory failure. RESULTS Patients admitted for asthma were significantly more likely to be female (374 females vs. 106 males, p <0.05). There was no difference between the genders comparing month of admission. The women were significantly older, with more Medicaid insured, and more anxiety/depression (p <0.05). There was no difference between the genders for obesity, race, tobacco history, gastroesophageal reflux disease (GERD), hypertension, diabetes, and pneumonia. There was no reported mortality. Using regression analysis, there was no difference between the genders for length of stay (odds ratio [OR] = 1.06, 95% confidence interval [CI] 0.97-1.17) and respiratory failure (OR = 1.58, 95% CI 0.53-4.76). Men stayed significantly longer in the ICU (OR = 1.18, 95% CI 1.01-1.38). CONCLUSIONS Patients admitted with asthma are significantly more likely to be female. Males stay significantly longer in the ICU. There is no difference between the genders for length of stay and respiratory failure. There was no reported mortality for either gender.

The Influence of Ethnicity on Patient Satisfaction

Objective To investigate the influence of ethnicity on patient satisfaction with hospitalization care. Methods We conducted a random selection, cross-sectional study. Data were collected by telephone interviews over a three-year period utilizing a 16-question survey. Patients were excluded from the study if they were admitted for an obstetric visit, physical rehabilitation, or psychiatric illness or if we were unable to reach them by telephone. We used logistic regression to compare ethnicity with the responses for each of the 16 questions while controlling for three confounders (age, gender, and insurance status). For each question, patient responses of excellent and very good were considered satisfied. Patient responses of good, fair, and poor were considered not satisfied. Results We surveyed 7,795 patients. Compared to African-Americans, non-Hispanic white Americans were significantly older, included more males, and were insured by Medicaid less often (p < 0.05). Using multivariate analysis, we found that seven of the 16 questions exhibited significant satisfaction differences. African-Americans expressed significantly less satisfaction for two of six questions related to nursing care, two of three questions related to entire staff care, one of two question related to physician care, and one of three questions related to overall satisfaction (p < 0.05). However, African-Americans expressed significantly more satisfaction for one question related to nursing care. There was no difference between the two groups for nine of the 16 questions, including both questions regarding communication and coordination. Conclusion African-Americans reported significantly lower rates of satisfaction compared to non-Hispanic white Americans for six of 16 questions regarding satisfaction during hospitalization care.

Coronary artery bypass grafting in patients with dialysis-dependent end stage renal disease: a prospective, nested case-control study.

Abstract  Objective: To assess if coronary artery bypass grafting (CABG) patients with dialysis‐dependent end stage renal disease (ESRD) experience greater intraoperative and postoperative morbidity and mortality compared to CABG patients without ESRD. Methods: We conducted a nested case–control study from an 8‐year hospitalization cohort in which data were collected prospectively. Inclusion criteria included CABG surgery and age greater than 18 years. Cases were patients with dialysis dependent ESRD (N = 28) and controls were patients without ESRD (N = 84). Cases were matched to controls 1:3 on age, gender, tobacco history, and New York Heart Association Functional Class. The outcomes of interest were mortality, intensive care unit length of stay, total length of hospitalization, time on the ventilator, wound complications, pulmonary complications, neurological complications, gastrointestinal complications, arrhythmia, and intraoperative complications. Using logistic regression we controlled for 13 potential confounding variables. Results: There were no significant differences between the groups with the exception of total length of hospitalization. Patients with dialysis‐dependent ESRD had a significantly longer total hospitalization stay (21%) than patients without ESRD. There were no significant differences for the remaining nine outcomes of interest, including perioperative morbidity or mortality. Conclusion: Intraoperative and postoperative morbidity and mortality for CABG were not increased for patients with dialysis‐dependent ESRD compared to patients without ESRD. However, patients on dialysis undergoing CABG experienced a greater length of hospitalization than patients undergoing CABG who were not on dialysis.

Serum Chromium and Gestational Diabetes

Objective: To prospectively assess if chromium levels are different in gestational diabetics than in nondiabetic pregnant women. Therapeutic options could exist if levels are different. Methods: We conducted a 2-year prospective, gestational cohort study. The cohort included newly diagnosed pregnant patients. Two blood samples were taken, the first at consent, the second at the time of diabetes screening. Results: Five hundred eighty patients entered the cohort. One hundred fifty-five were lost to follow up and 425 patients completed the study (396 nondiabetics and 29 diabetics). The patients with gestational diabetes were significantly older, with a family history of gestational diabetes, and were significantly more likely to have been a gestational diabetic in a previous pregnancy (P < 05). There was no significant difference between the 2 groups for chromium levels both at enrollment (0.15 ± 0.06 ng/mL vs 0.14 ± 0.03 ng/mL; P = .28) and during the second trimester (0.14 ± 0.06 ng/mL vs 0.14 ± 0.04 ng/mL; P = .82). Conclusion: Serum chromium levels do not exhibit any significant variation between gestational diabetic women and nondiabetic women when assessed prospectively.

The influence of gender on adults admitted for asthma

BACKGROUND In the United States, the prevalence of asthma is not only higher than in most other countries, it also varies greatly between diverse populations. Only limited data exist that examine the variation of outcomes by gender in patients admitted to a hospital for asthma. OBJECTIVE This study assessed outcome differences based on gender in adults who were admitted nationally with the primary diagnosis of asthma. METHODS A retrospective cohort study was conducted of all patients who were admitted to a hospital with the primary diagnosis of asthma in 2002-2005 and were reported in the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. Patients were excluded if they were aged <18 years or had an additional diagnosis of chronic obstructive pulmonary disease. RESULTS A total of 590,410 patients (439,991 women, 150,419 men) were included in the study. Patients admitted for asthma were significantly more likely to be female (P < 0.05). Women were significantly older compared with men (mean [SD], 48.5 [17.4] vs 44.6 [17.0] years, respectively), had a longer length of stay (3.44 vs 2.84 days), were more likely to be white (37.9% vs 34.2%), and had a higher total cost of admission (

Autologous blood transfusion in elective cardiac valve operations.

10,575 vs

Is it cost-effective to require recreational ice hockey players to wear face protection?

9390) (all, P < 0.05). Women were more likely than men to need a tracheostomy (adjusted odds ratio [AOR] = 2.04; 95% CI, 1.77-2.35) and to have a bronchoscopy (AOR =1.12; 95% CI, 1.05-1.21). Men were significantly more likely than women to have arterial blood gases performed (AOR = 1.15; 95% Cl, 1.05-1.27) and to be intubated (AOR = 1.18; 95% Cl, 1.10-1.26) (both, P < 0.05). Men were significantly more likely to be admitted as an emergency admission (AOR = 1.10; 95% Cl, 1.04-1.18) and to die during hospitalization (AOR =1.69; 95% CI, 1.41-2.03). CONCLUSION Although they were less likely to be admitted to a hospital, men were more likely to be admitted as an emergency and to experience worse outcomes compared with women, in this study of adults with asthma in the United States.

Correlation of the Change in the International Normalized Ratio and Decreasing the Coumadin Dosage Following Total Joint Arthroplasty

Abstract  Background and Aim of Study: The aim of this study was to detect any outcome differences between patients who donated autologous blood versus nondonors undergoing nonemergent cardiac valve surgery. Of further interest was whether autologous donors required less allogeneic blood products overall than patients who did not donate. Methods: We conducted a nested case‐control study in which data were collected prospectively on 225 variables. Cases underwent nonemergent, cardiac valve surgery and donated autologous blood products (n = 40). Controls also had nonemergent, cardiac valve surgery but did not donate autologous blood products (n = 120). Cases were matched to controls 1:3 on age (±3 years), gender, and New York Heart Association Functional Classification. We controlled for 12 potential confounding variables and examined 17 outcomes of interest. To generate the unadjusted risks of each outcome, chi‐square and t‐tests were performed comparing cases and controls to each outcome of interest. Then logistic regression analysis investigated the adjusted risk between cases and controls and for the outcomes of interest, each controlling for the potential confounding variables. Results: There were no significant differences between the cases and controls for 11 of the 12 possible confounding variables. Controls had significantly more chronic obstructive pulmonary disorder. There were no significant differences between cases and controls for 13 of the 17 outcomes of interest. Autologous blood donors received more total packed red blood cells (PRBCs) (p = 0.0373) and more total fresh frozen plasma than controls (p = 0.0002). Fewer autologous blood donors required allogeneic packed red blood cell transfusion (p = 0.0134), and the total length of stay was shorter for autologous donors (p = 0.0782). Conclusion: Four of the 17 outcomes of interest were different for patients who donated autologous blood versus those who did not. Our experience demonstrated that elective cardiac valve surgery can safely reduce (by 18.3%) the need for allogeneic PRBCs by utilizing preoperative autologous blood donation.

Cardiac Surgery in Octogenarians Does Age Alone Influence Outcomes

Objective: The purpose of this study was to determine the cost-effectiveness of requiring all recreational hockey players to wear facial protection. Methods: The authors randomly surveyed recreational hockey players at two indoor hockey rinks in Evendale, Ohio. Data were collected on face protection, injuries, demographic variables and attitudes about protective gear from 11/2005 to 03/2006. Results: We surveyed 190 players. The mean age was 34 ± 8.7 years and 99% were male. The average hockey experience was 17 years. Forty-six percent of respondents reported at least one serious hockey injury in the last five years. Twenty-four percent of the surveyed population chose to not wear face protection (46/190). The average cost of face protection was