Impact of Gender on Outcomes Following Surgery for Infective Endocarditis: A Systematic Review and Meta‐Analysis

Objective Outcomes after surgical management of infective endocarditis (IE) for male and female patients is controversial, with some studies suggesting worse outcomes for female patients. The aim of this systematic review was to assess postoperative outcomes after surgery for IE in all studies reporting by patient gender. Methods A systematic review and meta‐analysis was conducted in accordance with Preferred Reporting in Systematic Review and Meta‐Analysis (PRISMA) guidelines. A comprehensive search of MEDLINE, Embase and Scopus databases was conducted from inception until 15th September 2025. Two authors independently conducted study screening and data extraction. Outcomes included mortality (< 30 day and > 1 year), postoperative (< 30 day) stroke, sepsis, acute kidney injury (AKI) and length of stay (LOS). Results Database search yielded 3102 results, and 13 studies were included with 20,824 patients (14,479 male and 6345 female). Women had increased risk of 30‐day mortality compared with men (odds ratio (OR): 1.36, 95% confidence interval (CI): 1.15–1.61 and p < 0.01), increased risk of > 1‐year mortality (OR: 1.34, 95% CI: 1.04–1.73 and p = 0.02) and of developing postoperative (< 30 day) AKI (OR: 1.20, 95% CI: 1.03–1.41 and p = 0.02). No significant differences were found in postoperative stroke (OR: 1.12, 95% CI: 0.95–1.30 and p = 0.17), sepsis (OR: 1.03, 95% CI: 0.62–1.71 and p = 0.92) or LOS (standardised mean difference: −0.06 days, 95% CI: −0.71‐0.59 and p = 0.78). Conclusions Female patients had significantly worse short‐ and long‐term mortality and increased risk of developing AKI than men; however, stroke, sepsis and LOS outcomes were comparable. Further research is needed to determine the reasons for worse mortality outcomes in females.