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Women are more likely than men to die from complications from high-risk cardiovascular surgery, a new study shows.

These life-threatening complications, such as heart attacks and infections, were more likely to be recognized too late in women than in men, resulting in the higher death rate seen in women. Not recognizing or responding quickly enough to complications is referred to as “rescue failure“by doctors.

The new study, published Oct. 16 in the journal JAMAanalyzed the medical records of more than 860,000 patients who underwent high-risk surgery between October 2015 and February 2020. All procedures involved heart or blood vessels, including surgical repair aneurysmsheart bypass surgery and heart valve replacements.

Overall, about 15% of these patients experienced some complication following the procedure; a similar rate of complications was seen in men and women. But of the total group, nearly 11 percent of women died of complications, compared with 8.6 percent of men. The researchers concluded that this difference was likely caused by delays in doctors recognizing and treating the women’s complications, which included heart attacksblood clots in the lungs, kidney failure, lung failure, pneumonia, bleeding and surgical site infections.

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Dr. Mario Gaudinoa heart surgeon at Weill Cornell Medical Center and New York Presbyterian Hospital, who was not involved in the research, described the study as a “warning” to the long-overlooked disparities in men’s and women’s outcomes after major surgery.

Notably, women in the study were also more likely to receive care at teaching hospitals and bigger high volume hospitalscompared to men. These types of facilities are associated with better quality care than other medical centers, such as low-volume hospitals—however, the higher mortality rate for women was consistent across the different facilities.

“If anything, these results show how widespread the problem is,” he said Dr. Catherine Wagnercardiac surgery resident at the University of Michigan and lead author of the study. “This suggests that there is a systemic problem that contributes to the underrecognition and undertreatment of postoperative complications in women,” Wagner told Live Science in an email.

The study does not draw definitive conclusions about the factors that might cause this disparity. Previous research has focused on women’s tendency to have surgery at older ages than men, meaning they may be dealing with more underlying medical conditions and are at a more advanced stage of the disease. These characteristics were reflected in the women in the new study, who, on average, were slightly older and had a slightly higher rate of comorbidities than the men.

However, while these are relevant factors, they fail to fully account for the results of the study, which found a much higher death rate among women, despite men and women having similar rates and types of complications , he said. Dr. Andrei Churyla, a cardiac surgeon at Northwestern Medical Group in Chicago, who was not involved in the study.

Unconscious bias against women could be a possible explanation, he said. There is a tendency for healthcare providers to dismiss women’s pain, which can delay or even prevent proper diagnosis and treatment. A 2022 study in Journal of the American Heart Association found that young women who complained of chest pain had a 29% longer wait time for heart attack evaluation than young men, for example.

Lack of understanding of the female heart may also influence patient outcomes, Gaudino suggested. “As cardiovascular physicians, I think we’ve had the wrong approach of thinking that women are actually like men, or just little men,” he said. “The mistake we’re making is continuing to treat women with approaches that we know work for men.”

Until recently, much of the research focused on cardiac surgery overwhelmingly male populationsand few studies have been done specifically in female patients, Gaudino said.

In addition, diagnostic criteria for complications were developed based on data from male patients, so they may not account for differences in women’s underlying physiology and how these complications manifest in them. For example, high levels of troponin, a protein in the heart muscle, signal that a heart attack is imminent—but the cutoff for what counts as “high” has been derived primarily from men, who have higher baseline troponin levels than women, he said.

Gaudino suspects that the female body is still misunderstood by doctors, and that this means that complications that would be easily flagged in male patients are more likely to go unnoticed, and therefore untreated, in female patients.

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There has been a recent effort to strengthen research in this area to better understand and address the gap in surgical outcomes between men and women.

“I think we have to constantly remind ourselves that women are different from men,” he said Dr. Brittany Zwischenbergera heart surgeon at Duke Health in Durham, North Carolina. “And our current focus on sex and gender will hopefully result in tailored approaches to surgery and their post-operative course and ultimately reduce disparities. But really, this (study) is an opportunity for us to improve postoperative care for all patients.”

This article is for informational purposes only and is not intended to provide medical advice.

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