Gender-Based Disparities for Outcomes in Esophagectomy
Emily L. Larson1, Jessica M. Ruck2, Alice L. Zhou1, Stephen C. Yang2, Richard J. Battafarano2, Stephen R. Broderick2, Errol L. Bush2, Jinny S. Ha2.
1Johns Hopkins School of Medicine, Baltimore, MD, USA, 2Johns Hopkins Hospital, Baltimore, MD, USA.
BACKGROUND: Gender-based differences in outcomes of esophagectomy have been noted with conflicting results outside the U.S. The goal of this study was to address this gap by evaluating outcomes of esophagectomy by gender on a national scale.
METHODS: We identified adult patients undergoing esophagectomy from 2010-2019 using the ACS-NSQIP database via CPT code. Emergent cases and those lacking patient gender data were excluded. Descriptive statistics compared baseline and surgical characteristics by gender. The primary outcome was any complication by postoperative day 30. Multivariable logistic regression was used to calculate the adjusted odds ratio (aOR) for variables associated with complication.
RESULTS: 8,823 patients were identified, with 1,726 (19.6%) female. Female patients were younger (45.39 vs. 46.91 years, p<0.001), had lower body mass index (27.18 vs. 27.92 kg/m2, p<0.001), were more racially diverse (p<0.001), and had fewer comorbidities. Female patients had a shorter average operative time (326.1 vs 350.3 minutes, p<0.001) and lower American Society of Anesthesiologists (ASA) class (p=0.02). Females had more complications (46.2% vs 39.9%, p<0.001), stratified in Table 1. No difference was noted in renal, neurologic, or wound complications. Female gender was a significant risk factor for complication in the adjusted model (aOR=1.45, 95% CI=1.30-1.62, Figure 1).
CONCLUSIONS: In this national sample of esophagectomy patients, female gender was associated with 45% higher odds of a postoperative complication within 30 days, after adjusting for baseline and surgical characteristics. This gender-based disparity is the first characterized in a U.S. nation-wide sample and needs to be addressed.
| Outcome | Female (n = 1726) | Male (n = 7097) | P |
| Hospital length of stay *mean (SD) | 11.02 (19.27) | 11.37 (18.43) | <.0001 |
| Any complication | 797 (46.2%) | 2831 (39.9%) | <.0001 |
| Failure to wean ventilation | 216 (12.5%) | 728 (10.3%) | .01 |
| Urinary tract infection | 85 (4.9%) | 110 (1.5%) | <.0001 |
| Myocardial infarction | 7 (0.4%) | 88 (1.2%) | .004 |
| Bleeding requiring transfusion | 345 (20.0%) | 988 (13.9%) | <.0001 |
| Return to operating room | 243 (14.1%) | 1003 (14.1%) | .99 |
| 30-day mortality | 46 (2.7%) | 197 (2.8%) | .87 |
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