Abstract 4373099: Gender Disparities in ECMO Utilization and Outcomes in Cardiogenic Shock: Insights from the Nationwide Inpatient Sample

Abstract

Background: Despite advances in extracorporeal membrane oxygenation (ECMO) for cardiogenic shock (CS), little is known about gender-based differences in its utilization and clinical outcomes. We aimed to assess whether gender influences ECMO use and outcomes in CS using Nationwide Inpatient Sample (NIS) Database. Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS, 2016–2020), identifying adults (≥18 years) hospitalized with cardiogenic shock. ECMO use was identified using ICD-10-PCS codes. Survey-weighted logistic and linear regression models were used to assess gender differences in ECMO utilization, in-hospital mortality, length of stay (LOS), hospitalization costs, and major complications. Models adjusted for demographics, comorbidities (Elixhauser index), and hospital characteristics. Results: Among 13,005 patients receiving ECMO for CS, only 33.9% were female. Female patients were significantly less likely to receive ECMO (adjusted OR 0.89; 95% CI 0.82–0.97; p = 0.011). Female ECMO recipients were younger than males (mean age 47.7 vs. 52.8 years; p < 0.001). There was no significant difference in in-hospital mortality by gender (aOR 1.12; 95% CI 0.92–1.35; p = 0.258). Length of stay was similar between genders (23.6 days), with a non-significant trend toward shorter LOS in females (β = –2.25; p = 0.071). Adjusted total hospital charges were significantly lower in females (β = –$95,269; p = 0.017) (Figure 1). Notably, complication rates varied by gender. Females had significantly lower adjusted odds of requiring dialysis (aOR 0.77; 95% CI 0.63–0.95; p = 0.013), developing acute kidney injury (aOR 0.71; 95% CI 0.57–0.88; p = 0.002), arrhythmias (aOR 0.67; 95% CI 0.56–0.80; p < 0.001), and acute myocardial infarction (aOR 0.75; 95% CI 0.61–0.92; p = 0.007). However, female patients had higher adjusted odds of developing pericardial complications (aOR 1.35; 95% CI 1.04–1.74; p = 0.022) and pulmonary embolism (aOR 1.68; 95% CI 1.25–2.26; p = 0.001) (Figure 2). Conclusions: Women were less likely to receive ECMO for cardiogenic shock and tended to be younger at the time of receiving it. While in-hospital mortality and length of stay did not differ by gender, females had significantly lower hospital charges and distinct complication patterns. These findings highlight potential gender-based disparities in ECMO utilization and underscore the need for further investigation to ensure equitable access and outcomes.