National outcomes following benign cardiac tumor resection: A critical sex-based disparity

Background: Treatment of benign primary cardiac tumors involves surgical resection, but reported outcomes from multi-institutional or national databases are scarce. This study examines contemporary national outcomes following surgical resection of benign primary atrial and ventricular tumors.

Methods: The 2016-2018 Nationwide Readmissions Database was queried for all patients ≥18 years with a primary diagnosis of benign neoplasm of the heart who underwent resection of the atria, ventricles, or atrial/ventricular septum. Primary outcomes were 30-day mortality, readmission, and composite morbidity (defined as stroke, permanent pacemaker implantation, bleeding complication, or acute kidney injury). Multivariable analysis was used to identify independent predictors of worse outcomes.

Results: A weighted total of 2557 patients met inclusion criteria. Mean age was 61 years, 67.9% were female, and patients had relatively low comorbidity burdens (mean Charlson Comorbidity Index 1.39). The majority of patients underwent excision of the left atrium (71.5%), followed by the intra-atrial septum (26.6%), right atrium (2.9%). There was no difference in 30-day mortality (2.1% vs. 1.3%, p = .550), 30-day readmission (7.0% vs. 9.1%, p = .222), or 30-day composite morbidity (56.8% vs. 53.8%, p = .369) between females and males, respectively. However, on multivariable analysis, female sex was independently associated with increased risk of 30-day mortality (adjusted odds ratio = 2.65, p = .028). Tumor location (atria, ventricles, septum) was not predictive of mortality.

Conclusion: Benign atrial and ventricular tumors are uncommon, but disproportionately impact female patients, with female sex being an independent predictor of 30-day mortality. Root-cause analysis is necessary to determine the ultimate cause of this disparity.