Sammon Jesse, Trinh Quoc-Dien, Sun Maxine, Bianchi Marco, Schmitges Jan, Shariat Shahrokh F, Ghani Khurshid R, Sukumar Shyam, Jeldres Claudio, Briganti Alberto, Perrotte Paul, Rogers Craig G, Peabody James O, Montorsi Francesco, Menon Mani, Karakiewicz Pierre I
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA.
Can J Urol. 2012 Aug;19(4):6337-44.
The effect of gender on complications after surgery is controversial. We examine the effect of gender on five short term nephrectomy outcomes.
Within the Health Care Utilization Project, Nationwide Inpatient Sample (NIS) we focused on nephrectomies performed within the most contemporary years (1998-2007). We tested the rates of blood transfusions, extended length of stay, in-hospital mortality, as well as intraoperative and postoperative complications, stratified according to gender. Multivariable logistic regression analyses fitted with general estimation equations for clustering among hospitals further adjusted for confounding factors. Separate multivariable analyses were performed for open radical nephrectomy (ORN), open partial nephrectomy (OPN), laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN).
Overall, 48172 nephrectomies were identified. Of those, female patients accounted 39.4% of cases (n = 18966). Female gender was associated with higher rates of blood transfusions (p < 0.001) and higher rates of prolonged length of stay (p < 0.001). Conversely, female gender was associated with lower rates of postoperative complications (p < 0.001) and in-hospital mortality (p = 0.015). In multivariable analyses, female patients had higher rates of blood transfusion (OR = 1.22, p < 0.001) but significantly lower rates of postoperative complications (OR = 0.81, p < 0.001) and in-hospital mortality. No statistically significant differences were recorded when accounting for intraoperative complications and length of stay beyond the median (all p > 0.05). Gender as a predictor of outcomes was most pronounced in OPN and LPN.
Nephrectomies performed in female patients are associated with lower rates of postoperative complications and in-hospital mortality. Conversely, blood transfusions rates are higher in these patients. Gender disparities in perioperative outcomes are most pronounced after OPN.
性别对手术后并发症的影响存在争议。我们研究了性别对五项短期肾切除术结果的影响。
在医疗保健利用项目的全国住院患者样本（NIS）中，我们重点关注了最近几年（1998 - 2007年）进行的肾切除术。我们测试了输血率、住院时间延长、院内死亡率以及术中及术后并发症发生率，并根据性别进行分层。采用一般估计方程对医院间聚类进行多变量逻辑回归分析，进一步调整混杂因素。对开放性根治性肾切除术（ORN）、开放性部分肾切除术（OPN）、腹腔镜根治性肾切除术（LRN）和腹腔镜部分肾切除术（LPN）分别进行多变量分析。
总体而言，共识别出48172例肾切除术。其中，女性患者占病例的39.4%（n = 18966）。女性与较高的输血率（p < 0.001）和较长的住院时间延长率（p < 0.001）相关。相反，女性与较低的术后并发症率（p < 0.001）和院内死亡率（p = 0.015）相关。在多变量分析中，女性患者输血率较高（OR = 1.22，p < 0.001），但术后并发症率（OR = 0.81，p < 0.001）和院内死亡率显著较低。在考虑术中并发症和中位住院时间以上的住院时间时，未记录到统计学上的显著差异（所有p > 0.05）。性别作为结果的预测因素在OPN和LPN中最为明显。
女性患者进行的肾切除术与较低的术后并发症率和院内死亡率相关。相反，这些患者的输血率较高。围手术期结果的性别差异在OPN后最为明显。
