Long-Term Survival of Women After Cardiac Surgery: A Two-Decade Perspective

Background: Previous studies have highlighted sex-based differences in outcomes following cardiac surgery, with women often experiencing worse long-term survival compared to men due to a combination of biological, clinical, and systemic factors. This study investigates whether long-term mortality among women undergoing cardiac surgery has improved over two decades.

Methods: A retrospective analysis was conducted on cardiac surgeries performed from 2004–2024 at a single tertiary center, divided into two periods (before and after January 2014). The hazard ratio (HR) for mortality associated with female sex was assessed in each time period using multivariable Cox proportional hazards models. Interaction analysis between sex and period was performed to evaluate differences over time.

Results: The study included 15,777 patients (16,483 surgeries) with a median age of 64 years (IQR 57–73). In the earlier cohort, the HR for long-term mortality in women compared to men was 1.26 (95% CI: 1.13–1.41, p<0.001). In the late cohort, the HR decreased to 1.05 (95% CI: 0.92–1.21, p=0.445). The interaction term for sex and time period indicated a significant improvement in women’s relative survival over time (HR=0.83, 95% CI: 0.70–0.99, p=0.038).

Conclusion: The findings suggest that while women historically faced higher long-term mortality risk following cardiac surgery, this disparity has markedly reduced over the last two decades. These results may reflect advancements in surgical techniques, postoperative care, and broader systemic improvements in healthcare access and delivery. Further investigation is warranted to identify specific contributors to this trend and to ensure continued progress in optimizing outcomes for women undergoing cardiac surgery.