Surgical Teams Fail to Rescue Female Patients 10.7 Percent of the Time: JAMA Surgery
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Despite having no greater chance of developing problems after high-risk cardiovascular surgery, women are more likely than men to die from postoperative complications, a University of Michigan-led study suggests.
Men and women had a similar rate of complications after an operation, around 15%. However, women died of those complications at a significantly higher rate: Surgical teams failed to rescue female patients 10.7% of the time, compared to 8.6% for male patients. The results are published in JAMA Surgery.
Researchers found a similar pattern in the failure-to-rescue rate for each individual procedure. The most common complications for men and women were kidney failure, pneumonia, and lung failure.
In fact, women in the study were more likely to receive surgery at hospitals that, traditionally, take on a higher volume of high-risk surgeries.
“These high-risk procedures are expected to have higher compliantly education rates, but patients are still expected to have a positive outcome if the complication is managed quickly,” said co-author Gorav Ailawadi, M.D, M.B.A., chair of cardiac surgery at U-M Health and a director of the University of Michigan Health Frankel Cardiovascular Center “In our study, female patients had a lower rate of reoperation than males,” he added, using a term to mean a second operation within days of the first. “This may not be due to a lower need for reoperation; it could instead be a signal that their complications were not appropriately addressed.”
The explanation, so far, has largely centered around the fact that women are older when they receive surgery and have more comorbidities than men. Women also have smaller anatomy and vessel size, which can make surgery more technically difficult. This disparity is in addition to previous studies that have found that signs and symptoms of common diseases, such as heart attack and stroke, are more often either missed or not taken seriously for female patients.
“After accounting for patient comorbidities and patient risk, we found that men and women had similar rates and types of complications; however, women remained more likely to die from those complications,” said co-author Andrew Ibrahim, M.D., M.Sc., associate professor of surgery at U-M Medical School and co-director of the Michigan Medicine Center for Healthcare Outcomes and Policy.
“In addition to reducing complications overall, we must focus on what happens after a complication occurs. Similarly, we have an opportunity after surgery to improve early recognition when a female patient is having a complication before it cascades to a point where we cannot rescue them. Improving the recognition and response to postoperative complications, especially for women, is needed to reduce longstanding disparities on outcomes after high-risk surgery.”
Reference: Wagner CM, Joynt Maddox KE, Ailawadi G, Ibrahim AM. Failure to Rescue Female Patients Undergoing High-Risk Surgery. JAMA Surg. Published online October 16, 2024. doi:10.1001/jamasurg.2024.4574
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