Sex differences in utilisation of extracorporeal membrane oxygenation support and outcomes in Taiwan
Abstract Background The impact of sex-related differences in patients receiving extracorporeal membrane oxygenation support (ECMO) support is still inconclusive. This population-based study aimed to investigate sex differences in short- or long-term outcomes in order to improve clinical practice. Me...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-023-02045-9 |
| _version_ | 1797863747735257088 |
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| author | Feng-Cheng Chang An-Hsun Chou Yu-Tung Huang Jhen-Ling Huang Victor Chien-Chia Wu Chih-Hsiang Chang Kuo-Chun Hung Shang-Hung Chang Pao-Hsien Chu Shao-Wei Chen |
| author_facet | Feng-Cheng Chang An-Hsun Chou Yu-Tung Huang Jhen-Ling Huang Victor Chien-Chia Wu Chih-Hsiang Chang Kuo-Chun Hung Shang-Hung Chang Pao-Hsien Chu Shao-Wei Chen |
| author_sort | Feng-Cheng Chang |
| collection | DOAJ |
| description | Abstract Background The impact of sex-related differences in patients receiving extracorporeal membrane oxygenation support (ECMO) support is still inconclusive. This population-based study aimed to investigate sex differences in short- or long-term outcomes in order to improve clinical practice. Methods Patients who received ECMO between 2001 to 2017 were identified from the Taiwan National Health Insurance Research Database. Propensity score matching with a 1:1 ratio was conducted in female-to-male groups, to reduce confounding of baseline covariates. Outcomes included in-hospital mortality, all-cause mortality, all-cause readmission, and ECMO-related complications. Logistic regression analysis, Cox proportional hazard model, and join point regression were used to compare sex differences in both short- or long-term outcomes. Results In total, 7,010 matched patients from 11,734 ECMO receivers were included for analysis. The use of ECMO increased dramatically in past years, although the proportion of females was still lower than males. There was a decreasing trend of females undergoing ECMO over time. Female patients have lower risks of in-hospital mortality (64.08% in females vs 66.48% in males; P = 0.0352) and ECMO-related complications compared with males. Furthermore, females also had favorable long-term late outcomes such as all-cause mortality (73.35% in females vs 76.98% in males; P = 0.009) and readmission rate (6.99% in females vs 9.19% in males; P = 0.001). Conclusions Female patients had more favorable in-hospital and long-term survival outcomes. Despite improvement in modern ECMO technique and equipment, ECMO remains underutilized in eligible female patients. Thus, females should undergo ECMO treatment if available and indicated. Trial registration The institutional review board of Chang Gung Memorial Hospital approved all data usage and the study protocol (registration number: 202100151B0C502; date of registration: 23/08/2021). |
| first_indexed | 2024-04-09T22:40:34Z |
| format | Article |
| id | doaj.art-7bc26ada8d69456493a95e773125302b |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-09T22:40:34Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-7bc26ada8d69456493a95e773125302b2023-03-22T12:12:36ZengBMCBMC Anesthesiology1471-22532023-03-0123111010.1186/s12871-023-02045-9Sex differences in utilisation of extracorporeal membrane oxygenation support and outcomes in TaiwanFeng-Cheng Chang0An-Hsun Chou1Yu-Tung Huang2Jhen-Ling Huang3Victor Chien-Chia Wu4Chih-Hsiang Chang5Kuo-Chun Hung6Shang-Hung Chang7Pao-Hsien Chu8Shao-Wei Chen9Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityDepartment of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityCenter for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical CenterCenter for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical CenterDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical CenterDivision of Nephrology, Department of Internal Medicine, Linkou Chang Gung Memorial HospitalDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical CenterCenter for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical CenterDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical CenterCenter for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical CenterAbstract Background The impact of sex-related differences in patients receiving extracorporeal membrane oxygenation support (ECMO) support is still inconclusive. This population-based study aimed to investigate sex differences in short- or long-term outcomes in order to improve clinical practice. Methods Patients who received ECMO between 2001 to 2017 were identified from the Taiwan National Health Insurance Research Database. Propensity score matching with a 1:1 ratio was conducted in female-to-male groups, to reduce confounding of baseline covariates. Outcomes included in-hospital mortality, all-cause mortality, all-cause readmission, and ECMO-related complications. Logistic regression analysis, Cox proportional hazard model, and join point regression were used to compare sex differences in both short- or long-term outcomes. Results In total, 7,010 matched patients from 11,734 ECMO receivers were included for analysis. The use of ECMO increased dramatically in past years, although the proportion of females was still lower than males. There was a decreasing trend of females undergoing ECMO over time. Female patients have lower risks of in-hospital mortality (64.08% in females vs 66.48% in males; P = 0.0352) and ECMO-related complications compared with males. Furthermore, females also had favorable long-term late outcomes such as all-cause mortality (73.35% in females vs 76.98% in males; P = 0.009) and readmission rate (6.99% in females vs 9.19% in males; P = 0.001). Conclusions Female patients had more favorable in-hospital and long-term survival outcomes. Despite improvement in modern ECMO technique and equipment, ECMO remains underutilized in eligible female patients. Thus, females should undergo ECMO treatment if available and indicated. Trial registration The institutional review board of Chang Gung Memorial Hospital approved all data usage and the study protocol (registration number: 202100151B0C502; date of registration: 23/08/2021).https://doi.org/10.1186/s12871-023-02045-9Extracorporeal membrane oxygenationECMOSex differencesMortalityWomen |
| spellingShingle | Feng-Cheng Chang An-Hsun Chou Yu-Tung Huang Jhen-Ling Huang Victor Chien-Chia Wu Chih-Hsiang Chang Kuo-Chun Hung Shang-Hung Chang Pao-Hsien Chu Shao-Wei Chen Sex differences in utilisation of extracorporeal membrane oxygenation support and outcomes in Taiwan BMC Anesthesiology Extracorporeal membrane oxygenation ECMO Sex differences Mortality Women |
| title | Sex differences in utilisation of extracorporeal membrane oxygenation support and outcomes in Taiwan |
| title_full | Sex differences in utilisation of extracorporeal membrane oxygenation support and outcomes in Taiwan |
| title_fullStr | Sex differences in utilisation of extracorporeal membrane oxygenation support and outcomes in Taiwan |
| title_full_unstemmed | Sex differences in utilisation of extracorporeal membrane oxygenation support and outcomes in Taiwan |
| title_short | Sex differences in utilisation of extracorporeal membrane oxygenation support and outcomes in Taiwan |
| title_sort | sex differences in utilisation of extracorporeal membrane oxygenation support and outcomes in taiwan |
| topic | Extracorporeal membrane oxygenation ECMO Sex differences Mortality Women |
| url | https://doi.org/10.1186/s12871-023-02045-9 |
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