Sex differences in the treatment and outcome of emergency general surgery

Abstract

BackgroundSociodemographic characteristics, such as sex, have been shown to influence health care delivery. Acute care surgery models are effective in decreasing mortality and morbidity after emergency surgeries, but sex-based differences in delivery and outcomes have not been explored. Our objective was to explore sex associated differences in the patient characteristics and clinical outcomes of those admitted to emergency general surgery.MethodsA post-hoc analysis of 512 emergency general surgical patients admitted consecutively to two tertiary care hospitals in Alberta Canada, between April 1, 2014 and July 31, 2015. We measured associations between sex and patient demographics, pre-, intra- and post-operative delivery of care, as well as post-operative outcomes.FindingsOf those excluded from the analysis, older females were more likely to undergo conservative management compared to older men (41% vs 34%, p = 0.03). Overall, there were no differences between sexes for time from admission to surgery, time spent in surgery, overall complication rate, mortality, hospital length of stay, or discharge disposition. Women were more likely to have a cancer diagnosis [OR 4.12 (95% CI: 1.61–10.5), p = 0.003, adjusted for age], while men were more likely to receive hernia surgery [OR 2.33 (95% CI 1.35–4.02), p = 0.002, adjusted for age and Charlson Comorbidity Index]. Finally, men were more likely to have a major respiratory complication [OR 2.73 (95% CI: 1.19–6.24), p = 0.02, adjusted for age].ConclusionsOnly two differences in peri and post-operative complications between sexes were noted, which suggests sex-based disparity in quality of care is limited once a decision has been made to operate. Future studies with larger databases are needed to corroborate our findings and investigate potential sex biases in surgical versus conservative management.

Predictors of In‐Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospitalizations

“…Here, we analyse all kinds of surgical procedures together and find that female patients were less likely to die than male patients. There are some papers that show a similar trend [ 32 ], but others found no differences between the sexes with respect to mortality [ 33 ]. Therefore, this issue requires more detailed studies in the future.…”

Medical student exposure to women’s health concepts and practices: a content analysis of curriculum at Canadian medical schools

“…Medical education must expand to include a range of healthcare conditions, and beyond the lifespan context to consider not only healthcare conditions, but also issues and challenges that affect women’s health and health care. Considerable research has established wide-spread gendered inequities in access to and quality of care [ 7 – 19 , 23 , 24 ], further exacerbated by social determinants of health such as race, ethnicity, culture, education and employment, and other research shows that women’s healthcare concerns and questions are often dismissed [ 20 – 22 ]. One way to address these problems is to ensure that future generations of physicians are aware of these issues and understand what can be done at the individual, organizational and system levels to prevent and mitigate such inequities.…”

“…Research in Canada between 2003 and 2012 revealed that women were less likely than men to receive ideal care for a range of conditions [ 7 , 8 ]. More recent Canadian research also identified gendered disparities in care delivery and patient outcomes for various health conditions including cardiovascular disease [ 9 – 12 ], HIV management [ 13 , 14 ], hip fracture [ 15 ], chronic obstructive pulmonary disease [ 16 ], mental illness [ 17 , 18 ], and emergency surgery [ 19 ]. Another 1225 Canadian women said that truncated discussion of health issues was a frequent problem [ 20 ].…”

The effect of iron deficiency and anaemia on women’s health

“…In surgical settings, sex discrepancies exist in both elective and non‐elective situations, where worse outcomes have been reported in women [17, 45, 46]. Women are more likely than men to be iron deficient pre‐operatively [24] and peri‐operative blood transfusion rates are higher in women [47].…”