Sex differences in the treatment and outcome of emergency general surgery


Autoři: Diana Rucker aff001;  Lindsey M. Warkentin aff002;  Hanhmi Huynh aff002;  Rachel G. Khadaroo aff002
Působiště autorů: Department of Medicine, Division of Geriatrics, University of Alberta, Edmonton, AB, Canada aff001;  Department of Surgery, University of Alberta, Edmonton, AB, Canada aff002;  Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224278

Souhrn

Background

Sociodemographic 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.

Methods

A 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.

Findings

Of 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].

Conclusions

Only 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.

Klíčová slova:

Critical care and emergency medicine – Death rates – Digestive system procedures – Hospitals – Surgical and invasive medical procedures – Surgical oncology – Surgical repair – Trauma surgery


Zdroje

1. Schroder J, Kahlke V, Staubach KH, Zabel P, Stuber F. Gender differences in human sepsis. Arch Surg. 1998;133(11):1200–5. Epub 1998/11/20. doi: 10.1001/archsurg.133.11.1200 9820351.

2. Eachempati SR, Hydo L, Barie PS. Gender-based differences in outcome in patients with sepsis. Arch Surg. 1999;134(12):1342–7. Epub 1999/12/11. doi: 10.1001/archsurg.134.12.1342 10593332.

3. Vaccarino V, Parsons L, Every NR, Barron HV, Krumholz HM. Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants. N Engl J Med. 1999;341(4):217–25. Epub 1999/07/22. doi: 10.1056/NEJM199907223410401 10413733.

4. Alter DA, Naylor CD, Austin PC, Tu JV. Biology or bias: practice patterns and long-term outcomes for men and women with acute myocardial infarction. J Am Coll Cardiol. 2002;39(12):1909–16. Epub 2002/06/27. doi: 10.1016/s0735-1097(02)01892-2 12084587.

5. Weaver WD, White HD, Wilcox RG, Aylward PE, Morris D, Guerci A, et al. Comparisons of characteristics and outcomes among women and men with acute myocardial infarction treated with thrombolytic therapy. GUSTO-I investigators. Jama. 1996;275(10):777–82. Epub 1996/03/13. 8598594.

6. Dueck AD, Johnston KW, Alter D, Laupacis A, Kucey DS. Predictors of repair and effect of gender on treatment of ruptured abdominal aortic aneurysm. J Vasc Surg. 2004;39(4):784–7. Epub 2004/04/09. doi: 10.1016/j.jvs.2003.10.064 15071441.

7. Evans SM, Adam DJ, Bradbury AW. The influence of gender on outcome after ruptured abdominal aortic aneurysm. J Vasc Surg. 2000;32(2):258–62. Epub 2000/08/05. doi: 10.1067/mva.2000.106948 10917984.

8. Oh ES, Sieber FE, Leoutsakos JM, Inouye SK, Lee HB. Sex Differences in Hip Fracture Surgery: Preoperative Risk Factors for Delirium and Postoperative Outcomes. J Am Geriatr Soc. 2016;64(8):1616–21. Epub 2016/07/08. doi: 10.1111/jgs.14243 27384742; PubMed Central PMCID: PMC5038922.

9. Giacomini MK. Gender and ethnic differences in hospital-based procedure utilization in California. Arch Intern Med. 1996;156(11):1217–24. Epub 1996/06/10. 8639016.

10. Kent JA, Patel V, Varela NA. Gender disparities in health care. Mt Sinai J Med. 2012;79(5):555–9. Epub 2012/09/15. doi: 10.1002/msj.21336 22976361.

11. Raine R, Goldfrad C, Rowan K, Black N. Influence of patient gender on admission to intensive care. J Epidemiol Community Health. 2002;56(6):418–23. Epub 2002/05/16. doi: 10.1136/jech.56.6.418 12011195; PubMed Central PMCID: PMC1732172.

12. Stone PH, Thompson B, Anderson HV, Kronenberg MW, Gibson RS, Rogers WJ, et al. Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction: The TIMI III registry. Jama. 1996;275(14):1104–12. Epub 1996/04/10. 8601930.

13. Bierman AS. Sex matters: gender disparities in quality and outcomes of care. CMAJ. 2007;177(12):1520–1. Epub 2007/11/16. doi: 10.1503/cmaj.071541 18003953; PubMed Central PMCID: PMC2096490.

14. Gijsbers van Wijk CM, van Vliet KP, Kolk AM. Gender perspectives and quality of care: towards appropriate and adequate health care for women. Soc Sci Med. 1996;43(5):707–20. Epub 1996/09/01. doi: 10.1016/0277-9536(96)00115-3 8870135.

15. Althans AR, Brady JT, Keller DS, Stein SL, Steele SR, Times M. Are we catching women in the safety net? Colorectal cancer outcomes by gender at a safety net hospital. Am J Surg. 2017;214(4):715–20. Epub 2017/09/19. doi: 10.1016/j.amjsurg.2017.07.022 28918849.

16. Amri R, Stronks K, Bordeianou LG, Sylla P, Berger DL. Gender and ethnic disparities in colon cancer presentation and outcomes in a US universal health care setting. J Surg Oncol. 2014;109(7):645–51. Epub 2014/01/30. doi: 10.1002/jso.23567 24474677.

17. Gao RN, Neutel CI, Wai E. Gender differences in colorectal cancer incidence, mortality, hospitalizations and surgical procedures in Canada. J Public Health (Oxf). 2008;30(2):194–201. Epub 2008/05/01. doi: 10.1093/pubmed/fdn019 18445612.

18. Thiels CA, Holst KA, Ubl DS, McKenzie TJ, Zielinski MD, Farley DR, et al. Gender disparities in the utilization of laparoscopic groin hernia repair. J Surg Res. 2017;210:59–68. Epub 2017/05/02. doi: 10.1016/j.jss.2016.10.028 28457341.

19. Armenia SJ, Pentakota SR, Merchant AM. Socioeconomic factors and mortality in emergency general surgery: trends over a 20-year period. J Surg Res. 2017;212:178–86. Epub 2017/05/30. doi: 10.1016/j.jss.2017.01.015 28550905.

20. Schwartz DA, Hui X, Schneider EB, Ali MT, Canner JK, Leeper WR, et al. Worse outcomes among uninsured general surgery patients: does the need for an emergency operation explain these disparities? Surgery. 2014;156(2):345–51. Epub 2014/06/24. doi: 10.1016/j.surg.2014.04.039 24953267.

21. Khadaroo RG, Padwal RS, Wagg AS, Clement F, Warkentin LM, Holroyd-Leduc J. Optimizing senior’s surgical care—Elder-friendly Approaches to the Surgical Environment (EASE) study: rationale and objectives. BMC Health Services Research. 2015;15(1):338. doi: 10.1186/s12913-015-1001-2 26293153

22. World Health O. ICD-10: international statistical classification of diseases and related health problems / World Health Organization. Geneva: World Health Organization; 2004.

23. Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Annals of Surgery. 2004;240(2):205–13. doi: 10.1097/01.sla.0000133083.54934.ae PMC1360123. 15273542

24. Grewal K, Wijeysundera DN, Carroll J, Tait G, Beattie WS. Gender differences in mortality following non-cardiovascular surgery: an observational study. Can J Anaesth. 2012;59(3):255–62. Epub 2011/11/23. doi: 10.1007/s12630-011-9629-9 22105602.

25. Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, et al. Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med. 2000;342(14):1016–22. Epub 2000/04/06. doi: 10.1056/NEJM200004063421405 10749964.

26. Borkhoff CM, Hawker GA, Kreder HJ, Glazier RH, Mahomed NN, Wright JG. The effect of patients' sex on physicians' recommendations for total knee arthroplasty. CMAJ. 2008;178(6):681–7. Epub 2008/03/12. doi: 10.1503/cmaj.071168 18332383; PubMed Central PMCID: PMC2263116.

27. Karlson EW, Daltroy LH, Liang MH, Eaton HE, Katz JN. Gender differences in patient preferences may underlie differential utilization of elective surgery. Am J Med. 1997;102(6):524–30. Epub 1997/06/01. doi: 10.1016/s0002-9343(97)00050-8 9217666.

28. Siccoli A, Staartjes VE, de Wispelaere MP, Schroder ML. Gender differences in degenerative spine surgery: Do female patients really fare worse? Eur Spine J. 2018;27(10):2427–35. Epub 2018/08/23. doi: 10.1007/s00586-018-5737-3 30132176.

29. Elliss-Brookes L, McPhail S, Ives A, Greenslade M, Shelton J, Hiom S, et al. Routes to diagnosis for cancer—determining the patient journey using multiple routine data sets. Br J Cancer. 2012;107(8):1220–6. Epub 2012/09/22. doi: 10.1038/bjc.2012.408 22996611; PubMed Central PMCID: PMC3494426.

30. Peterson CY, Osen HB, Tran Cao HS, Yu PT, Chang DC. The battle of the sexes: women win out in gastrointestinal surgery. J Surg Res. 2011;170(1):e23–8. Epub 2011/06/23. doi: 10.1016/j.jss.2011.04.017 21693379.

31. George RL, McGwin G Jr., Metzger J, Chaudry IH, Rue LW 3rd. The association between gender and mortality among trauma patients as modified by age. J Trauma. 2003;54(3):464–71. Epub 2003/03/14. doi: 10.1097/01.TA.0000051939.95039.E6 12634524.

32. Liu T, Xie J, Yang F, Chen JJ, Li ZF, Yi CL, et al. The influence of sex on outcomes in trauma patients: a meta-analysis. Am J Surg. 2015;210(5):911–21. Epub 2015/07/07. doi: 10.1016/j.amjsurg.2015.03.021 26145388.

33. Bird MD, Karavitis J, Kovacs EJ. Sex differences and estrogen modulation of the cellular immune response after injury. Cell Immunol. 2008;252(1–2):57–67. Epub 2008/02/26. doi: 10.1016/j.cellimm.2007.09.007 18294625; PubMed Central PMCID: PMC2544631.

34. Fowler RA, Sabur N, Li P, Juurlink DN, Pinto R, Hladunewich MA, et al. Sex-and age-based differences in the delivery and outcomes of critical care. CMAJ. 2007;177(12):1513–9. Epub 2007/11/16. doi: 10.1503/cmaj.071112 18003954; PubMed Central PMCID: PMC2096494.

35. Romo H, Amaral AC, Vincent JL. Effect of patient sex on intensive care unit survival. Arch Intern Med. 2004;164(1):61–5. Epub 2004/01/14. doi: 10.1001/archinte.164.1.61 14718323.

36. Haider AH, Herrera-Escobar JP, Al Rafai SS, Harlow AF, Apoj M, Nehra D, et al. Factors Associated With Long-Term Outcomes After Injury: Results of the Functional Outcomes and Recovery After Trauma Emergencies (FORTE) Multicenter Cohort Study. Ann Surg. 2018. Epub 2018/12/15. doi: 10.1097/SLA.0000000000003101 30550382.

37. Kodra N, Shpata V, Ohri I. Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery. Open Access Maced J Med Sci. 2016;4(2):259–63. Epub 2016/06/24. doi: 10.3889/oamjms.2016.059 27335597; PubMed Central PMCID: PMC4908742.

38. Yoon DY, Mansukhani NA, Stubbs VC, Helenowski IB, Woodruff TK, Kibbe MR. Sex bias exists in basic science and translational surgical research. Surgery. 2014;156(3):508–16. Epub 2014/09/02. doi: 10.1016/j.surg.2014.07.001 25175501.


Článek vyšel v časopise

PLOS One


2019 Číslo 11