Sex-related Disparity in Surgical Mortality among Pediatric Patients


Ruey-Kang Chang, MD, MPH, UCLA Pediatric Cardiology, B2-427 MDCC, 10833 Le Conte Avenue, Los Angeles, CA 90024, USA. Tel: (+1) 310-825-6197; Fax: (+1) 310-825-9524; E-mail:


Background.  It has been reported that gender differences in cardiovascular outcomes found in adults also are present in children who undergo surgical repair for congenital heart disease.

Methods.  California statewide hospital discharge data 1989–99 were used to study outcomes in children <18 years undergoing cardiac surgery. Hospital discharge data were linked to death registry data to study postdischarge death within 30 days of discharge. We used logistic regression to evaluate the effect of gender on mortality controlling for age, race and ethnicity, type of insurance, household income, date and month of surgery, type of admission, hospital case volume, and various types of procedures.

Results.  There were 25 402 cardiac surgery cases with 1505 in-hospital deaths (mortality rate of 5.92%). An additional 37 deaths occurred within 30 days after hospital discharge. Crude mortality rates for males (5.99%) and females (5.84%) were not significantly different. However, fewer neonates were female and females underwent a higher proportion of low-risk procedures than males. Logistic regression revealed that females, compared with males, had a significantly higher odds ratio (OR) for in-hospital mortality (OR = 1.18, P < .01) and overall (up to 30 days post discharge) mortality (OR = 1.18, P < .01). The risk-adjusted length of hospital stay was similar between females and males while charges per hospital day were slightly higher in females than males. The prevalence of Down syndrome, pulmonary hypertension, and failure to thrive were higher in females.

Conclusions.  Female gender is associated with an 18% higher in-hospital and 30-day postdischarge mortality as compared with male gender. There was no difference in length of hospital stay between males and females. The mechanism by which female gender acts as a risk factor requires further investigation.