Sex differences in the treatment and outcome of emergency general surgery

English version

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
prolekare.web.journal.doi_sk: https://doi.org/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:

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

Zdroje

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