Universität zu Köln

Damanakis, Alexander I., Toader, Justus, Wahler, Isabell, Plum, Patrick, Quaas, Alexander, Ernst, Angela ORCID: 0000-0003-2375-1889, Popp, Felix, Gebauer, Florian and Bruns, Christiane (2022). Influence of patient sex on outcomes after pancreatic surgery: multicentre study. Br. J. Surg., 109 (8). S. 746 - 754. OXFORD: OXFORD UNIV PRESS. ISSN 1365-2168

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Abstract

Background Recent findings support the hypothesis of sex-related differences in inflammatory and immunological responses to trauma. The aim of this study was to address sex-specific aspects in patients who underwent pancreatic surgery. Methods This retrospective study used data from the German StuDoQ registry. Patients who underwent pancreatic surgery between 2010 and 2020 were stratified according to procedure (pancreatic head resection, distal pancreatectomy (DP), total pancreatectomy (TP)). Each cohort underwent propensity score matching (PSM) with the co-variables BMI, ASA, age, coronary heart disease (CHD), diabetes, hypertension with medication, and histology to level the distribution of co-morbidities between men and women. The main outcomes were morbidity and mortality. Results The total cohort consisted of 10 224 patients (45.3 per cent women). Men had higher ASA grades, and more often had CHD, diabetes, and hypertension with medication. Women had fewer overall complications (57.3 versus 60.1 per cent; P = 0.005) and a lower mortality rate (3.4 versus 4.9 per cent; P < 0.001). Rates of pancreatic surgery-specific complications, such as clinically relevant postoperative pancreatic fistula (POPF) (grade B/C: 14 versus 17 per cent; P < 0.001), delayed gastric emptying (grade B/C: 7.8 versus 9.2 per cent; P = 0.014), and postpancreatectomy haemorrhage (grade B/C: 7.1 versus 9.0 per cent; P < 0.001), were also lower in women. After PSM, 8358 patients were analysed. In the pancreatic head resection cohort (5318 patients), women had fewer complications (58.6 versus 61.4 per cent; P = 0.044), a lower in-hospital mortality rate (3.6 versus 6.1 per cent; P < 0.001), and less often had clinically relevant POPF (11.6 versus 16.2 per cent; P < 0.001). After DP, the clinically relevant POPF rate was lower in women (22.5 versus 27.3 per cent; P = 0.012). In the TP cohort, men more often developed intra-abdominal abscess requiring drainage (5.0 versus 2.3 per cent; P = 0.050). Conclusion Women had favourable outcomes after pancreatic surgery. Sex-related differences are emerging in medicine. Data are rare in pancreatic surgery, which is still associated with considerable morbidity and mortality. This study showed, in a large patient cohort, that women have significantly fewer complications after surgery, even after propensity score matching for co-morbidities.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Damanakis, Alexander I. UNSPECIFIED UNSPECIFIED UNSPECIFIED Toader, Justus UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahler, Isabell UNSPECIFIED UNSPECIFIED UNSPECIFIED Plum, Patrick UNSPECIFIED UNSPECIFIED UNSPECIFIED Quaas, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Ernst, Angela UNSPECIFIED orcid.org/0000-0003-2375-1889 UNSPECIFIED Popp, Felix UNSPECIFIED UNSPECIFIED UNSPECIFIED Gebauer, Florian UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruns, Christiane UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-665179
DOI:	10.1093/bjs/znac128
Journal or Publication Title:	Br. J. Surg.
Volume:	109
Number:	8
Page Range:	S. 746 - 754
Date:	2022
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1365-2168
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTERNATIONAL STUDY-GROUP; RISK-FACTORS; GENDER; MANAGEMENT; FISTULA; INJURY; WOMEN Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/66517