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From the Center for Informatics and Perioperative Management, Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami/Jackson Memorial Hospital, Miami, Florida.
Address correspondence and reprint requests to Michael M. Vigoda, MD, MBA, Department of Anesthesiology, Perioperative Medicine and Pain Management, 1611 NW 12th Ave. (C-300), Miami, FL 33136. Address e-mail to mvigoda{at}med.miami.edu.
Abstract
BACKGROUND: Previous anesthesia information management systems-based studies have focused on intraoperative data analysis. Reviewing preoperative data could provide insight into the outpatient treatment of patients presenting for surgical procedures. As gender-based disparities have been demonstrated in the treatment of patients with cardiac disease, we hypothesized that there would be gender disparities in the outpatient pharmacologic management of patients with coronary artery disease (CAD) scheduled for elective noncardiac surgery.
METHODS: We analyzed electronic medical records of ambulatory patients with CAD (prior myocardial infarction [MI], coronary artery bypass surgery, and angioplasty with or without stenting, angina) presenting for elective noncardiac surgery between 1/2004 and 6/2006 (30 mo) at an inner city hospital.
RESULTS: Of 21,039 ambulatory patients seen in the preanesthesia clinic, 6.4% (1346) had CAD. Patients with CAD: Men were more likely to be taking β-blockers (P < 0.002), statins (P < 0.0001), aspirin (P < 0.0001), and antiplatelet medications (P < 0.04), although there was a trend of increased use of aspirin (P < 0.01) by women over the course of the study. Patients with history of prior MI: Men with a prior MI were more likely to be taking β-blockers (P < 0.0001) and statins (P < 0.02), although there was a trend of increased use of β-blockers (P < 0.0005) and aspirin (P < 0.03) by women over the course of the study. Quarterly prevalence rates for outpatient medication use were greatest for β-blockers and least for aspirin. Patients were more likely to be taking a statin, aspirin, or oral antiplatelet medication if they were receiving chronic β-blocker therapy (P < 0.0001 for each medication).
CONCLUSION: Aggregating anesthesia management information systems data provides an epidemiological perspective of community care of patients presenting for surgery. We found that gender disparities in outpatient medical treatment of patients with CAD, which previously favored men, have diminished primarily as a result of increased use of these medications in women. Nonetheless, despite evidence supporting the use of risk-reduction strategies, our patients are undertreated with standard medical therapies.
This article has been cited by other articles:
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  K. Gelb and A. W. Gelb Sex and Gender in the Perioperative Period: Wake Up to Reality Anesth. Analg., July 1, 2008; 107(1): 1 - 3. [Full Text] [PDF]
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