Sex Disparity and Procedure-Related Differences in Achieving an Ideal Outcome After Pancreatic Surgery: A National Observational Cohort Study.

IF 3.8 2区 医学 Q1 SURGERY
Marcus Tt Roalsø, Linn Såve Nymo, Dyre Kleive, Kim Waardal, Rachel Dille-Amdam, Kjetil Søreide
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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.

胰腺手术后实现理想结果的性别差异和手术相关差异:一项全国观察性队列研究。
“理想结果”代表由复合终点定义的良好的术后过程。性别差异和手术类型可能会影响获得理想结果的机会。我们的目的是在全国队列中调查与实现理想胰腺切除术后预后相关的因素。方法:一个完整的全国队列的所有胰十二指肠切除术或左侧胰腺切除术在一个普遍的医疗保健系统。单变量和多变量logistic回归模型与手术和性别相关的结果相关。结果:2057例患者中,1950例(95%)纳入,1130例(57.9%)获得理想结果,性别差异显著(女性和男性分别为62.3%和54.1%,分别为P75岁;P=0.049)和糖尿病患病率(分别为12.8%对21.2%;结论:女性更容易获得理想的结果,并且在所有领域都有更好的结果。观察到的结果的性别差异需要对这些观察到的临床差异背后可能存在的假定生物学机制进行调查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.90
自引率
5.80%
发文量
1515
审稿时长
3-6 weeks
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.
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