Abstract
This systematic review and meta-analysis aimed to evaluate sex-based differences in surgical outcomes among patients with infective endocarditis (IE). A comprehensive search of three major medical databases identified ten studies encompassing 16,763 patients who underwent valvular surgery for IE. Of these, 70.8% were male (n = 11,873), and 29.2% were female (n = 4890). Female patients were generally older at the time of surgery. The most common causative pathogen was Staphylococcus aureus (28.4%), followed by Streptococcus (22.5%) and Enterococcus (4.1%). Females demonstrated lower aortic valve involvement (risk ratio [RR]: 0.80, 95% confidence interval [CI]: 0.67–0.96) but higher mitral valve involvement (RR: 1.30, 95% CI: 1.17–1.45, p < 0.001). They also had a reduced prevalence of Streptococcus (RR: 0.89, 95% CI: 0.81–0.98, p = 0.02) and Enterococcus (RR: 0.71, 95% CI: 0.62–0.82, p = 0.03) infections and a lower risk of abscess formation (RR: 0.87, 95% CI: 0.76–0.99, p = 0.03) compared to males. There was a significant difference in the in-hospital mortality between female and male patients (RR: 1.30, 95% CI: 1.04–1.61, p = 0.02). No significant sex-related differences were observed in the duration of hospitalization. However, significant sex-related differences were observed in the incidence of postoperative stroke (RR: 1.10, 95% CI: 1.02–1.20, p = 0.02). In summary, female patients undergoing surgery for IE face a higher risk of both in-hospital mortality and postoperative stroke compared to males, underscoring clinically meaningful sex-based disparities in short-term surgical outcomes. These findings emphasize the need for further studies to clarify these observations. (PROSPERO Registration: CRD42024602013).
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