Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA.
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
World J Surg. 2023 Apr;47(4):895-902. doi: 10.1007/s00268-023-06896-8. Epub 2023 Jan 9.
Sex disparities in access to health care in low-resource settings have been demonstrated. Still, there has been little research on the effect of sex on postoperative outcomes. We evaluated the relationship between sex and mortality after emergency abdominal surgery.
We performed a retrospective cohort study using the acute care surgery database at Kamuzu Central Hospital (KCH) in Malawi. We included patients who underwent emergency abdominal surgery between 2013 and 2021. We created a propensity score weighted Cox proportional hazards model to assess the relationship between sex and inpatient survival.
We included 2052 patients in the study, and 76% were males. The most common admission diagnosis in both groups was bowel obstruction. Females had a higher admission shock index than males (0.91 vs. 0.81, p < 0.001) and a longer delay from admission until surgery (1.47 vs. 0.79 days, p < 0.001). Females and males had similar crude postoperative mortality (16.3% vs. 15.3%, p = 0.621). The final Cox proportional hazards regression model was based on the propensity-weighted cohort. The mortality hazard ratio was 0.65 among females compared to males (95% CI 0.46-0.92, p = 0.014).
Our results show a survival advantage among female patients undergoing emergency abdominal surgery despite sex-based disparities in access to surgical care that favors males. Further research is needed to understand the mechanisms underlying these findings.
在资源匮乏的环境中，性别在医疗保健可及性方面的差异已得到证实。然而，关于性别的术后结局的影响的研究却很少。我们评估了性别与紧急腹部手术后死亡率之间的关系。
我们使用马拉维卡姆祖中央医院（KCH）的急性外科手术数据库进行了回顾性队列研究。我们纳入了 2013 年至 2021 年间接受紧急腹部手术的患者。我们创建了倾向评分加权 Cox 比例风险模型，以评估性别与住院期间生存率之间的关系。
我们纳入了 2052 例患者，其中 76%为男性。两组中最常见的入院诊断是肠梗阻。女性的入院休克指数高于男性（0.91 比 0.81，p<0.001），从入院到手术的时间间隔也更长（1.47 比 0.79 天，p<0.001）。女性和男性的术后粗死亡率相似（16.3%比 15.3%，p=0.621）。最终的 Cox 比例风险回归模型基于倾向评分加权队列。与男性相比，女性的死亡率风险比为 0.65（95%CI 0.46-0.92，p=0.014）。
尽管男性在获得外科治疗方面具有优势，但我们的研究结果显示，在接受紧急腹部手术的女性患者中，她们的生存优势明显。需要进一步的研究来了解这些发现的潜在机制。
