Marcus Tt Roalsø, Linn Såve Nymo, Dyre Kleive, Kim Waardal, Rachel Dille-Amdam, Kjetil Søreide
{"title":"Sex Disparity and Procedure-Related Differences in Achieving an Ideal Outcome After Pancreatic Surgery: A National Observational Cohort Study.","authors":"Marcus Tt Roalsø, Linn Såve Nymo, Dyre Kleive, Kim Waardal, Rachel Dille-Amdam, Kjetil Søreide","doi":"10.1097/XCS.0000000000001442","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>An 'ideal outcome' represents a favorable postoperative journey defined by a composite endpoint. Gender-disparities and type of surgery may influence the chance to achieve an ideal outcome. We aimed to investigate factors associated with achieving an ideal outcome after pancreatectomy in a national cohort.</p><p><strong>Methods: </strong>A complete nationwide cohort of all pancreatoduodenectomies or left-sided pancreatectomies across a universal healthcare system. Uni- and multivariable logistic regression models were performed related to procedure- and sex-related outcomes.</p><p><strong>Results: </strong>Of 2057 patients, 1950 (95%) were included and 1,130 (57.9%) achieved an ideal outcome, with significant sex-disparities (62.3% vs. 54.1% for women and men, respectively, P<0.001). Women experienced fewer severe complications (22.6% vs. 30.1%, P<0.001), had fewer reoperations (5.5% vs. 10.1%, P<0.001), and lower 30-day mortality (0.8% vs. 1.9%, P=0.026) compared to men. Women also had lower rates of extended length of stay (22.1% vs. 26.1%, P=0.038) and lower 30-day readmission-rates (18.1% vs. 23.4%, P=0.004). Female sex was a strong predictor of achieving an ideal outcome (OR 1.39, 95% CI: 1.15-1.69, P<0.001), as was distal pancreatectomy compared to pancreatoduodenectomy (adjusted OR 2.09, 95% CI: 1.69-2.59, P<0.001). Sex-distribution of procedures (pancreatectomy vs. left-sided resections) was similar. Women were slightly older (24.0% vs. 20.3% >75 years, respectively; P=0.049) and lover rates of diabetes (12.8% vs. 21.2%, respectively; P<0.001).</p><p><strong>Conclusion: </strong>Women more often achieved an ideal outcome and had better outcomes across all domains. Observed sex-disparities in outcome warrant investigation into putative biological mechanisms that may underlie these observed clinical differences.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American College of Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/XCS.0000000000001442","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: An 'ideal outcome' represents a favorable postoperative journey defined by a composite endpoint. Gender-disparities and type of surgery may influence the chance to achieve an ideal outcome. We aimed to investigate factors associated with achieving an ideal outcome after pancreatectomy in a national cohort.
Methods: A complete nationwide cohort of all pancreatoduodenectomies or left-sided pancreatectomies across a universal healthcare system. Uni- and multivariable logistic regression models were performed related to procedure- and sex-related outcomes.
Results: Of 2057 patients, 1950 (95%) were included and 1,130 (57.9%) achieved an ideal outcome, with significant sex-disparities (62.3% vs. 54.1% for women and men, respectively, P<0.001). Women experienced fewer severe complications (22.6% vs. 30.1%, P<0.001), had fewer reoperations (5.5% vs. 10.1%, P<0.001), and lower 30-day mortality (0.8% vs. 1.9%, P=0.026) compared to men. Women also had lower rates of extended length of stay (22.1% vs. 26.1%, P=0.038) and lower 30-day readmission-rates (18.1% vs. 23.4%, P=0.004). Female sex was a strong predictor of achieving an ideal outcome (OR 1.39, 95% CI: 1.15-1.69, P<0.001), as was distal pancreatectomy compared to pancreatoduodenectomy (adjusted OR 2.09, 95% CI: 1.69-2.59, P<0.001). Sex-distribution of procedures (pancreatectomy vs. left-sided resections) was similar. Women were slightly older (24.0% vs. 20.3% >75 years, respectively; P=0.049) and lover rates of diabetes (12.8% vs. 21.2%, respectively; P<0.001).
Conclusion: Women more often achieved an ideal outcome and had better outcomes across all domains. Observed sex-disparities in outcome warrant investigation into putative biological mechanisms that may underlie these observed clinical differences.
期刊介绍:
The Journal of the American College of Surgeons (JACS) is a monthly journal publishing peer-reviewed original contributions on all aspects of surgery. These contributions include, but are not limited to, original clinical studies, review articles, and experimental investigations with clear clinical relevance. In general, case reports are not considered for publication. As the official scientific journal of the American College of Surgeons, JACS has the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons.