What are the risks associated with bypass surgery?
As with any medical procedure, bypass surgery is associated with certain risks. However, these risks are usually outweighed by the fact that bypass surgery can lengthen life and greatly improve quality of life by alleviating symptoms such as chest pain and shortness of breath. Complications that may occur during or after bypass surgery include bleeding, infection, high blood pressure, abnormal heart rhythms (arrhythmias), and breathing difficulties. These complications are relatively rare, usually not serious, and resolve within a few weeks. However, more serious complications such as heart attack, stroke, or death can occur.
Bypass surgery has become safer as techniques improve. One database of more than 1 million bypass patients found that the death rate fell from 3.9% in 1990 to 3.0% in 1999. This was despite the fact that the average patient undergoing surgery in 1999 was older and sicker than the average patient in 1990.2
Women with certain conditions such as high blood pressure, diabetes, obesity, or peripheral vascular disease (blockages in arteries outside the heart, usually the legs) are at increased risk for complications after bypass surgery. If you have already had bypass surgery, you are also at higher risk, and the risk of surgery is generally higher for women over 70 years of age.
Are women more likely to die after bypass surgery?
Women are more likely to die in the hospital than men after bypass surgery. In 1999, the overall death rate for bypass surgery was about 3%.2 Between 1% and 8% of women who undergo bypass surgery die within 30 days, compared with 1% to 3% of men.3 This is largely because, compared with men, women who undergo bypass are older and are more likely to have additional health problems including heart failure, diabetes, high blood pressure, and high cholesterol. In addition, women have smaller blood vessels than men, which makes surgery more difficult and puts women at a higher risk of complications after surgery.4 Being female itself does not necessarily mean you will have a worse outcome, but if you are petite or have additional risk factors, you should consider yourself at higher-than-average risk.
Women and men fare equally well in the long-term after surgery; approximately 13% of patients die within 5 years. One large trial even found that women were less likely than men to have died 5 years after surgery.4 Some studies find that women have a slightly higher death rate as much as 18 years after bypass surgery, but any difference seen was small and probably due to their older age.5, 6
Heart disease is relatively rare in women younger than 50 years. However, when younger women develop heart disease, they are 2 to 3 times more likely to die than men of the same age.7 Younger women who require bypass surgery have higher death rates than young men, even after their smaller body size and other health conditions are taken into account. The reason for the high mortality rate in young women is not clear, and is also seen in younger women undergoing balloon angioplasty and stenting.
Do women have to stay in the hospital longer after surgery?
After bypass surgery, women generally have to stay in the hospital longer than men. They are also more likely to require blood transfusions during and after surgery than men, and when transfusions are given women require more units of blood. In one study, 65% of women and only 19% of men required blood transfusions.8 This difference is seen even when risk factors such as older age and other health conditions are taken into account. Most other complications (such as heart attack, difficulty breathing, wound infection, and irregular heart rhythms) occur as rarely in women as in men.
Do women recover more slowly than men after surgery?
Recovery after bypass surgery typically takes 4 to 8 weeks. Depression is common in the weeks immediately following surgery, during the most intense phase of recovery. However, these symptoms usually resolve as the patient begins to resume normal activities.
Women have a slower physical recovery, experience more physical symptoms, and have more severe adverse mood effects after surgery than men. Starting at about 6 weeks after surgery, both women and men are less anxious and less depressed than they were before surgery. One study found that even though both women and men improve after surgery, after 1 year women have more depressive symptoms and score lower on tests of physical and social functioning than men. However, there was no gender difference in anxiety, life satisfaction, or the time it took to return to work.9 Another study reported that women were twice as likely to be readmitted to the hospital (22% of women vs. 13% of men) and more often reported chest pain, constipation, and nausea or lack of appetite.10
Why do women recover more slowly after bypass surgery?
This may be related to the different social roles of women and men. Traditionally, women have more responsibilities in caring for the home and family than men, and may therefore experience a greater disruption when they are unable to perform these roles while recovering from surgery. Women undergoing bypass surgery are more likely to be unmarried or widowed and have less social support than men, which may contribute to a more difficult recovery. Despite having a harder recovery than men, women who have bypass surgery experience improved quality of life, fewer symptoms, and feel better physically and emotionally after surgery.
See also: Mental Recovery After a Heart Attack or Procedure
What neurological complications can occur?
As the population undergoing bypass surgery ages, the risk of neurological complications related to the heart-lung machine and stopping the heart increases. In a 1996 study, 3% of patients experienced serious neurological events within a week of surgery, including stroke or coma.11 In a 2001 study, 53% of patients had a decline in intellectual function at discharge from the hospital, and 42% of patients experienced such mental decline at 5 years after surgery.12, 13 Patients who experience these problems have a higher risk of death and worse long-term function than those who do not. Several studies have found that women are at a greater risk for adverse neurological and cognitive outcomes after surgery than men.14 Women undergoing bypass are more likely than men to have other risk factors for stroke such as high blood pressure, diabetes, and being older than 75 years. Surgery without the use of the heart-lung machine (performed on a beating heart) may reduce these complications, and therefore be of particular benefit to women.
