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

Abstract

BACKGROUND: An ideal outcome represents a favorable postoperative journey defined by a composite endpoint. Sex 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. STUDY DESIGN: This study examined 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 2,057 patients, 1,950 (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 with 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 (odds ratio 1.39, 95% CI 1.15 to 1.69, p < 0.001), as was distal pancreatectomy compared with pancreatoduodenectomy (adjusted odds ratio 2.09, 95% CI 1.69 to 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%, older than 75 years of age, respectively; p = 0.049) and lower rates of diabetes (12.8% vs 21.2%, respectively; p < 0.001). CONCLUSIONS: Women more often achieved an ideal outcome and had better outcomes across all domains. Observed sex disparities in outcomes warrant investigation into putative biological mechanisms that may underlie these observed clinical differences.

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