Sex-Related Differences in Acuity and Postoperative Complications, Mortality and Failure to Rescue

Yan, Qi; Kim, Jeong-Soo; Hall, Daniel E.; Shinall, Myrick C.; Reitz, Katherine M.; Stitzenberg, Karyn B.; Kao, Lillian S.; Wang, Chen-Pin; Wang, Zhu; Schmidt, Susanne; Brimhall, Bradley B.; Manuel, Laura; Jacobs, Michael A.; Shireman, Paula K.

doi:10.1016/j.jss.2022.09.012

Cited by 4 publications

(1 citation statement)

References 77 publications

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“…In the present series, women had significantly higher rates of major postoperative complications. Previously, a large American cohort displayed higher rates of mortality and failure to rescue in female compared with male patients presenting with acute surgical pathologies of similar severity 30 . Potential sex-related disparities at presenting symptoms, time to diagnosis and aggressive care were suggested to explain this intriguing finding.…”

Section: Discussionmentioning

confidence: 99%

Sex-related differences in oncologic outcomes, operative complications and health-related quality of life after curative-intent oesophageal cancer treatment: multicentre retrospective analysis

Mantziari,

Elliott,

Markar

et al. 2024

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Background Oesophageal cancer, in particular adenocarcinoma, has a strong male predominance. However, the impact of patient sex on operative and oncologic outcomes and recovery of health-related quality of life is poorly documented, and was the focus of this large multicentre cohort study. Methods All consecutive patients who underwent oncological oesophagectomy from 2009 to 2015 in the 20 European iNvestigation of SUrveillance after Resection for Esophageal cancer study group centres were assessed. Clinicopathologic variables, therapeutic approach, postoperative complications, survival and health-related quality of life data were compared between male and female patients. Multivariable analyses adjusted for age, sex, tumour histology, treatment protocol and major complications. Specific subgroup analyses comparing adenocarcinoma versus squamous cell cancer for all key outcomes were performed. Results Overall, 3974 patients were analysed, 3083 (77.6%) male and 891 (22.4%) female; adenocarcinoma was predominant in both groups, while squamous cell cancer was observed more commonly in female patients (39.8% versus 15.1%, P < 0.001). Multivariable analysis demonstrated improved outcomes in female patients for overall survival (HRmales 1.24, 95% c.i. 1.07 to 1.44) and disease-free survival (HRmales 1.22, 95% c.i. 1.05 to 1.43), which was caused by the adenocarcinoma subgroup, whereas this difference was not confirmed in squamous cell cancer. Male patients presented higher health-related quality of life functional scores but also a higher risk of financial problems, while female patients had lower overall summary scores and more persistent gastrointestinal symptoms. Conclusion This study reveals uniquely that female sex is associated with more favourable long-term survival after curative treatment for oesophageal cancer, especially adenocarcinoma, although long-term overall and gastrointestinal health-related quality of life are poorer in women.

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Section: Discussionmentioning

confidence: 99%

Sex-related differences in oncologic outcomes, operative complications and health-related quality of life after curative-intent oesophageal cancer treatment: multicentre retrospective analysis

Mantziari,

Elliott,

Markar

et al. 2024

BJS Open

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Social Determinants of Health Factors and Loss-To-Follow-Up in the Field of Vascular Surgery

Schutt,

Bohr,

Cao

et al. 2024

Annals of Vascular Surgery

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Differentiating Urgent from Elective Cases Matters in Minority Populations: Developing an Ordinal “Desirability of Outcome Ranking” to Increase Granularity and Sensitivity of Surgical Outcomes Assessment

Jacobs

Schmidt²,

Hall³

et al. 2023

Journal of the American College of Surgeons

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BACKGROUND: Surgical analyses often focus on single or binary outcomes; we developed an ordinal Desirability of Outcome Ranking (DOOR) for surgery to increase granularity and sensitivity of surgical outcome assessments. Many studies also combine elective and urgent procedures for risk adjustment. We used DOOR to examine complex associations of race/ethnicity and presentation acuity. STUDY DESIGN: NSQIP (2013 to 2019) cohort study assessing DOOR outcomes across race/ethnicity groups risk-adjusted for frailty, operative stress, preoperative acute serious conditions, and elective, urgent, and emergent cases. RESULTS: The cohort included 1,597,199 elective, 340,350 urgent, and 185,073 emergent cases with patient mean age of 60.0 ± 15.8, and 56.4% of the surgeries were performed on female patients. Minority race/ethnicity groups had increased odds of presenting with preoperative acute serious conditions (adjusted odds ratio [aORs] range 1.22 to 1.74), urgent (aOR range 1.04 to 2.21), and emergent (aOR range 1.15 to 2.18) surgeries vs the White group. Black (aOR range 1.23 to 1.34) and Native (aOR range 1.07 to 1.17) groups had increased odds of higher/worse DOOR outcomes; however, the Hispanic group had increased odds of higher/worse DOOR (aOR 1.11, CI 1.10 to 1.13), but decreased odds (aORs range 0.94 to 0.96) after adjusting for case status; the Asian group had better outcomes vs the White group. DOOR outcomes improved in minority groups when using elective vs elective/urgent cases as the reference group. CONCLUSIONS: NSQIP surgical DOOR is a new method to assess outcomes and reveals a complex interplay between race/ethnicity and presentation acuity. Combining elective and urgent cases in risk adjustment may penalize hospitals serving a higher proportion of minority populations. DOOR can be used to improve detection of health disparities and serves as a roadmap for the development of other ordinal surgical outcomes measures. Improving surgical outcomes should focus on decreasing preoperative acute serious conditions and urgent and emergent surgeries, possibly by improving access to care, especially for minority populations.

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Sex-Related Differences in Acuity and Postoperative Complications, Mortality and Failure to Rescue

Cited by 4 publications

References 77 publications

Sex-related differences in oncologic outcomes, operative complications and health-related quality of life after curative-intent oesophageal cancer treatment: multicentre retrospective analysis

Sex-related differences in oncologic outcomes, operative complications and health-related quality of life after curative-intent oesophageal cancer treatment: multicentre retrospective analysis

Social Determinants of Health Factors and Loss-To-Follow-Up in the Field of Vascular Surgery

Differentiating Urgent from Elective Cases Matters in Minority Populations: Developing an Ordinal “Desirability of Outcome Ranking” to Increase Granularity and Sensitivity of Surgical Outcomes Assessment

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