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The battle of the sexes: women win out in gastrointestinal surgery. J Surg Res 2011 Sep;170(1):e23-8

Date

06/23/2011

Pubmed ID

21693379

DOI

10.1016/j.jss.2011.04.017

Scopus ID

2-s2.0-80051553032   8 Citations

Abstract

BACKGROUND: Women have been shown to have worse outcomes compared with men after cardiac surgery, but fare better after traumatic injury. No study considers the impact of gender on outcomes after major gastrointestinal surgery. We hypothesize that the physiologic insults of a major abdominal operation are similar to an injury model; therefore, women will have improved outcomes.

MATERIAL AND METHODS: We performed a retrospective review of the NIS database from 1998 to 2007. Patients undergoing major gastrointestinal surgery were identified by ICD-9 procedure codes: esophageal (42.4), gastric (43.5-43.9), small intestine (45.6), large intestine (45.7-45.8 and 17.3), rectal (48.4-48.6), hepatic (50.2-50.3), biliary (51.3 and 51.6), and pancreatic (52.5-52.7). Exclusion criteria included age over 60 y and under 18 y, multiple operations, and a sexual developmental disorder (25.52, 75.27, and 25.9). The primary outcome measure was in-hospital death.

RESULTS: A total of 307,124 patients were identified, of whom 50.3% were women. Overall, there were 6574 (2.14%) deaths; 2.45% of men and 1.84% of women died (P < 0.001). In multivariate analysis, women were 21.1% less likely to die than men (OR = 0.789, 95% CI = 0.74-0.84). When subset analysis was performed, women had improved mortality in the following types of surgery: gastric (OR = 0.751, 95% CI = 0.60-0.94), small intestine (OR = 0.704, 95% CI = 0.63-0.79), large intestine (OR = 0.845, 95% CI = 0.77--0.93), hepatic (OR = 0.562, 95% CI = 0.41-0.77), and pancreatic (OR = 0.658, 95% CI = 0.49-0.89, see Fig. 1).

CONCLUSIONS: Our study demonstrates that women may have improved outcomes after some types of major gastrointestinal surgery; however, the mechanism by which this occurs is unclear. Future studies are needed to further evaluate this interesting phenomenon.

Author List

Peterson CY, Osen HB, Tran Cao HS, Yu PT, Chang DC

Author

Carrie Peterson MD, MS, FACS, FASCRS Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Comorbidity
Digestive System Surgical Procedures
Female
Humans
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Sex Characteristics
Treatment Outcome