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J Thorac Cardiovasc Surg 2003;126:932-935
© 2003 The American Association for Thoracic Surgery

Editorial

Is it gender, methodology, or something else?

^a Cleveland Clinic Foundation, Cardiothoracic Anesthesia, Cleveland, Ohio, USA
^b Stanford University School of Medicine, Department of Anesthesiology, Stanford, Calif, USA
^c Hahnemann University Hospital, Department of Anesthesiology, Philadelphia, Pa, USA
^d Emory University School of Medicine, Division of Cardiology, Altanta, Ga, USA

Received for publication June 24, 2003; revisions received July 16, 2003; accepted for publication July 21, 2003.

^* Address for reprints: Colleen Gorman Koch, MD, MS, The Cleveland Clinic Foundation, Cardiothoracic Anesthesia (G-3), 9500 Euclid Ave, Cleveland, OH 44195, USA
kochc@ccf.org

The first 300 words of the full text of this article appear below.

Are outcomes different?

The thesis that women are different from men is not argued in any more important venue than the surgical theatre. The questions of whether and why women have higher probabilities of poor outcomes after coronary artery bypass grafting (CABG) have been repeatedly asked. A common denominator among published investigations is that the preoperative profile of the female patient is vastly different from that of the male patient.

Some risk factors traditionally associated with increased morbidity and mortality after CABG are more commonly represented in the preoperative profile of the female patient. The extent to which these factors explain gender differences, however, varies among studies. Some investigations report higher adjusted mortality for women,^1-4 whereas others, with application of adjustment strategies, report similar in-hospital mortality between women and men,^5-9 and yet others report similar postoperative mortality for women and men despite differences in baseline characteristics.^10-13

How can multiple studies examining the role of gender in surgical outcomes lead to such varied conclusions despite similar analyses of observational databases? If one structures the question correctly, collects the necessary data, and performs the appropriate analysis, one should expect a consistent answer. On the subject of gender, is the question structured to be answered, is there some unmeasured or unknown biologic variable or process-of-care decision in the perioperative period that is influencing outcomes, or is it the variable application of statistical methodology?

Is it methodology?

Study design
Understanding the strengths and limitations of experimental versus observational study designs allows for a better understanding of the application of data analysis methods. The randomized controlled trial (RCT) is considered the gold standard when examining outcomes between groups. Specific design elements of the RCT include uniform selection and management of patients under controlled conditions in tertiary care centers. This reduces bias associated with the selection of patients and reduces the variability that results . . . [Full Text of this Article]

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