After bypass surgery, women have worse quality of life than men

November 24, 2003

DURHAM, N.C. - A study by Duke University Medical Center researchers has found that women do not derive the same long-term quality-of-life benefits as men following coronary artery bypass surgery. This conclusion was evident even after the researchers statistically adjusted their data to allow for the greater number of preoperative risk factors in women than in men.

The researchers speculate that there may be two reasons for this clear gender discrepancy - either women may not experience the same level of physical benefits from the surgery as men, or their lowered quality of life is less related to cardiac health than men.

The results of the Duke study were published today (Nov. 24, 2003) in the journal Psychosomatic Medicine. The research was support by the National Institutes of Health and the American Heart Association (AHA).

"We know that in general women receiving bypass surgery are sicker, older, more likely to live alone and have other preoperative differences that would appear to explain a compromised quality of life," said lead author Barbara Phillips-Bute, Ph.D., assistant research professor in department of anesthesiology. "However, when we control for all these factors, a significant difference still exists."

Both the American College of Cardiology and the AHA have issued guidelines stating that when physicians and patients discuss the option of surgery, quality of life should be considered as an important factor along with survival, Phillips-Bute said. When all bypass patients are taken together, the surgery does improve quality of life, she continued, adding however that little is known about the gender differences.

To better understand these gender differences, the Duke team enrolled in a clinical trial 280 patients (96 women and 184 men) who were to receive bypass surgery.

All were given a battery of tests that measured quality of life and cognitive status prior to surgery and one year later. The quality-of-life tests measured such factors as activities of everyday life, social support, general health perception, depression and anxiety, while the cognitive tests measured such areas as short-term memory, psychomotor skills, concentration and attention.

For their analysis, the team then statistically controlled for such patient characteristics as age, years of education, marital status, other diseases, hypertension, diabetes, race and baseline quality of life and cognitive scores.

"The female patients showed significantly worse outcomes than male patients after one year in several key areas of quality of life," Phillips-Bute said. "After adjusting for the baseline differences, women were at greater risk for mental difficulties and anxiety, as well as the perception that their ability to perform the activities of everyday life had diminished since the surgery

"In many of the domains, women start worse than men, finish worse than men, and have worse recovery profiles than men," she concluded.

While there was a significant difference in the quality-of-life measurements, the impairments to cognitive function attributable to the surgery were similar between men and women.

Since the differences between the genders cannot be totally explained by their pre-operative characteristics, the researchers offer two possible explanations.

First, studies have shown that women do not always receive the same surgical benefit as men, Phillips-Bute explained, adding that women's arteries are smaller and that the vessels used in the bypass do not tend to last as long. Additionally, women experience less relief from angina and breathlessness, have more bedridden days and tend to be taking more cardiac medications than men.

"The impaired quality of life we find in our analysis may be related to the generally poorer prognosis for women after bypass surgery," Phillips-Bute said.

Secondly, the diminished quality of life reported by women may be due to factors other than cardiac health.

"If the causes of lower quality of life in women are due more to environment or personality, this could account for the differences we saw in our analysis," she continued. "If this is the case, interventions other than bypass surgery would be needed for women to experience the same improvements as men."
-end-
Other members of the Duke team included Joseph Mathew, M.D., James Blumenthal, Ph.D., Kathleen Welsh-Bohmer, Ph.D., William White, Daniel Mark, M.D., Kevin Landolfo, M.D., and Mark Newman, M.D. All are members of the Duke Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors group.

Duke University Medical Center

Related Bypass Surgery Articles from Brightsurf:

Strict diet explains metabolic effect of gastric bypass surgery
In many studies, bariatric surgery has been highlighted as an almost magical method for weight loss and reversing type 2 diabetes.

Opium linked with more deaths after bypass surgery
The largest study on opium use and outcomes after bypass surgery has found that - in contrast to widely held beliefs - it is linked with more deaths and heart attacks.

Use of radial artery in heart bypass surgery improves patient outcomes
Patients undergoing heart bypass surgery lived longer and had better outcomes when surgeons used a segment of an artery from their arm, called the radial artery, instead of a vein from their leg, called the saphenous vein, to create a second bypass, according to research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Gastric bypass surgery may benefit muscle strength more than previously thought
Gastric bypass surgery improves relative muscle strength and physical performance in people with obesity, according to a study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Gastric bypass surgery associated with greater weight loss in adults
Adults with severe obesity had greater initial and sustained weight loss with gastric bypass surgery than either sleeve gastrectomy or adjustable gastric banding, according to a new study published today in the Annals of Internal Medicine.

Benefits of gastric bypass surgery linked to changes in sweet taste preference
Worldwide, the number of patients struggling with obesity is rapidly increasing in both adults and children.

Could drugs replace gastric bypass surgery?
Gastric bypass surgery is one of the most successful treatments for obesity and related disorders; however, some patients may not want to undergo surgery.

Diabetes reversal after bypass surgery linked to changes in gut microorganisms
Studies have shown that bariatric surgery can lead to remission of type 2 diabetes mellitus (T2DM) in rodents and humans, but this beneficial effect cannot be explained solely by weight loss.

Gastric bypass surgery at ages older than 35 years associated with improved survival
Lance E. Davidson, Ph.D., of Brigham Young University, Provo, Utah, and colleagues examined whether gastric bypass surgery is equally effective in reducing mortality in groups undergoing surgery at different ages.

High rate of symptoms, hospitalization following gastric bypass surgery for obesity
Although the vast majority of patients reported improved well-being after Roux-en-Y gastric bypass (RYGB) surgery, the prevalence of symptoms such as abdominal pain and fatigue were high and nearly one-third of patients were hospitalized, according to a study published online by JAMA Surgery.

Read More: Bypass Surgery News and Bypass Surgery Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.