TY - JOUR
T1 - Sex-Related Differences in Acuity and Postoperative Complications, Mortality and Failure to Rescue
AU - Yan, Qi
AU - Kim, Jeongsoo
AU - Hall, Daniel E.
AU - Shinall, Myrick C.
AU - Reitz, Katherine Moll
AU - Stitzenberg, Karyn B.
AU - Kao, Lillian S.
AU - Wang, Chen Pin
AU - Wang, Zhu
AU - Schmidt, Susanne
AU - Brimhall, Bradley B.
AU - Manuel, Laura S.
AU - Jacobs, Michael A.
AU - Shireman, Paula K.
N1 - Funding Information:
This research was supported by grant U01TR002393 (Kim, Hall, Stitzenberg, Kao, CP Wang, Brimhall, Schmidt, Manuel, Jacobs and Shireman), from the National Center for Advancing Translational Sciences and the Office of the Director, NIH; grant K12CA090625 (Shinall) from the National Cancer Institute , NIH; grant K76AG068436 (Shinall) and L30AG064730 (Reitz) and P30AG044271 (Shireman and Brimhall) from the National Institute on Aging , NIH; and grant 5T32HL0098036 (Reitz) from the National Heart, Lung, and Blood Institute , NIH.
Funding Information:
Dr Hall reported receiving grants from the National Institutes of Health and Veterans Administration during the conduct of this study; he also reported a consulting relationship with FutureAssure, LLC. Dr Shinall reported receiving grants from the National Cancer Institute and the National Institute on Aging during the conduct of the study. Dr Reitz reported receiving grant funding from the National Heart, Lung, and Blood Institute and National Institute on Aging . Dr Stitzenberg reported receiving grant funding from the National Institutes of Health . Dr Kao reported receiving royalties from Springer, Wolters-Klower, and McGraw-Hill. Dr Shireman reported receiving grants from the National Institutes of Health and Veterans Health Administration and salary support from Texas A&M University, South Texas Veterans Health Care System and the University of Texas Health San Antonio during the conduct of the study. No other disclosures were reported.
Funding Information:
Dr Hall reported receiving grants from the National Institutes of Health and Veterans Administration during the conduct of this study; he also reported a consulting relationship with FutureAssure, LLC. Dr Shinall reported receiving grants from the National Cancer Institute and the National Institute on Aging during the conduct of the study. Dr Reitz reported receiving grant funding from the National Heart, Lung, and Blood Institute and National Institute on Aging. Dr Stitzenberg reported receiving grant funding from the National Institutes of Health. Dr Kao reported receiving royalties from Springer, Wolters-Klower, and McGraw-Hill. Dr Shireman reported receiving grants from the National Institutes of Health and Veterans Health Administration and salary support from Texas A&M University, South Texas Veterans Health Care System and the University of Texas Health San Antonio during the conduct of the study. No other disclosures were reported.This research was supported by grant U01TR002393 (Kim, Hall, Stitzenberg, Kao, CP Wang, Brimhall, Schmidt, Manuel, Jacobs and Shireman), from the National Center for Advancing Translational Sciences and the Office of the Director, NIH; grant K12CA090625 (Shinall) from the National Cancer Institute, NIH; grant K76AG068436 (Shinall) and L30AG064730 (Reitz) and P30AG044271 (Shireman and Brimhall) from the National Institute on Aging, NIH; and grant 5T32HL0098036 (Reitz) from the National Heart, Lung, and Blood Institute, NIH.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/2
Y1 - 2023/2
N2 - Introduction: Yentl syndrome describing sex-related disparities has been extensively studied in medical conditions but not after surgery. This retrospective cohort study assessed the association of sex, frailty, presenting with preoperative acute serious conditions (PASC), and the expanded Operative Stress Score (OSS) with postoperative complications, mortality, and failure-to-rescue. Methods: The National Surgical Quality Improvement Program from 2015 to 2019 evaluating 30-d complications, mortality, and failure-to-rescue. Results: Of 4,860,308 cases (43% were male; mean [standard deviation] age of 56 [17] y), 6.0 and 0.8% were frail and very frail, respectively. Frailty score distribution was higher in men versus women (P < 0.001). Most cases were low-stress OSS2 (44.9%) or moderate-stress OSS3 (44.5%) surgeries. While unadjusted 30-d mortality rates were higher (P < 0.001) in males (1.1%) versus females (0.8%), males had lower odds of mortality (adjusted odds ratio (aOR) = 0.92, 95% confidence interval [CI] = 0.90-0.94, P < 0.001) after adjusting for frailty, OSS, case status, PASC, and Clavien-Dindo IV (CDIV) complications. Males have higher odds of PASC (aOR = 1.33, CI = 1.31-1.35, P < 0.001) and CDIV complications (aOR = 1.13, CI = 1.12-1.15, P < 0.001). Male-PASC (aOR = 0.76, CI = 0.72-0.80, P < 0.001) and male-CDIV (aOR = 0.87, CI = 0.83-0.91, P < 0.001) interaction terms demonstrated that the increased odds of mortality associated with PASC or CDIV complications/failure-to-rescue were lower in males versus females. Conclusions: Our study provides a comprehensive analysis of sex-related surgical outcomes across a wide range of procedures and health care systems. Females presenting with PASC or experiencing CDIV complications had higher odds of mortality/failure to rescue suggesting sex-related care differences. Yentl syndrome may be present in surgical patients; possibly related to differences in presenting symptoms, patient care preferences, or less aggressive care in female patients and deserves further study.
AB - Introduction: Yentl syndrome describing sex-related disparities has been extensively studied in medical conditions but not after surgery. This retrospective cohort study assessed the association of sex, frailty, presenting with preoperative acute serious conditions (PASC), and the expanded Operative Stress Score (OSS) with postoperative complications, mortality, and failure-to-rescue. Methods: The National Surgical Quality Improvement Program from 2015 to 2019 evaluating 30-d complications, mortality, and failure-to-rescue. Results: Of 4,860,308 cases (43% were male; mean [standard deviation] age of 56 [17] y), 6.0 and 0.8% were frail and very frail, respectively. Frailty score distribution was higher in men versus women (P < 0.001). Most cases were low-stress OSS2 (44.9%) or moderate-stress OSS3 (44.5%) surgeries. While unadjusted 30-d mortality rates were higher (P < 0.001) in males (1.1%) versus females (0.8%), males had lower odds of mortality (adjusted odds ratio (aOR) = 0.92, 95% confidence interval [CI] = 0.90-0.94, P < 0.001) after adjusting for frailty, OSS, case status, PASC, and Clavien-Dindo IV (CDIV) complications. Males have higher odds of PASC (aOR = 1.33, CI = 1.31-1.35, P < 0.001) and CDIV complications (aOR = 1.13, CI = 1.12-1.15, P < 0.001). Male-PASC (aOR = 0.76, CI = 0.72-0.80, P < 0.001) and male-CDIV (aOR = 0.87, CI = 0.83-0.91, P < 0.001) interaction terms demonstrated that the increased odds of mortality associated with PASC or CDIV complications/failure-to-rescue were lower in males versus females. Conclusions: Our study provides a comprehensive analysis of sex-related surgical outcomes across a wide range of procedures and health care systems. Females presenting with PASC or experiencing CDIV complications had higher odds of mortality/failure to rescue suggesting sex-related care differences. Yentl syndrome may be present in surgical patients; possibly related to differences in presenting symptoms, patient care preferences, or less aggressive care in female patients and deserves further study.
KW - Clavien-Dindo level IV
KW - Health disparities
KW - Present at the time of surgery
KW - Sex-related mortality
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U2 - 10.1016/j.jss.2022.09.012
DO - 10.1016/j.jss.2022.09.012
M3 - Article
C2 - 36244225
AN - SCOPUS:85140272710
SN - 0022-4804
VL - 282
SP - 34
EP - 46
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -