ImportanceFemale patients have higher mortality rates after high-risk surgery than male patients. It is unknown whether this mortality gap is due to different rates of postoperative complications or if complications are addressed differently by sex, causing complications to lead to death—so-called failure to rescue.ObjectiveTo evaluate sex differences in failure to rescue across high-risk surgical procedures.Design, Setting, and ParticipantsThis retrospective cohort study was conducted using data from Medicare beneficiaries from October 2015 to February 2020 who underwent high-risk vascular or cardiac surgical procedures, including abdominal aortic aneurysm repair, coronary artery bypass grafting, aortic valve replacement, and mitral valve replacement or repair. Data analysis was performed from August 2023 to March 2024.ExposuresThe primary exposure was patient sex.Main Outcomes and MeasuresThe primary outcomes were risk-adjusted rates of complications, 30-day mortality, and failure to rescue, which was defined as a death occurring after a serious complication. Categorical variables are presented as frequencies and proportions and compared using χ2 analysis. Continuous variables were tested for normality and compared using a t test.ResultsA total of 863 305 Medicare beneficiaries were included in this study cohort, of whom 304 176 (35.2%) were female. Mean (SD) age was slightly higher in female patients (74.8 [9.3] years) than male patients (73.4 [8.5] years), and female patients had more comorbidities than male patients (≥2 Elixhauser comorbidities, female: 262 809 [86.4%] vs male: 465 231 [83.2%]). Female patients were more likely to receive care at large hospitals and hospitals with a higher surgical case volume. Overall, female and male patients had similar rates of complications (female: 14.98% vs male: 14.37%; adjusted relative risk [aRR], 1.04; 95% CI, 1.03-1.05; P < .001). However, female patients had higher rates of 30-day mortality (female: 4.22% vs male: 3.34%; aRR, 1.26; 95% CI, 1.23-1.29; P < .001) and higher rates of failure to rescue (female: 10.71% vs male: 8.58%; aRR, 1.25; 95% CI, 1.22-1.28; P < .001). A similar pattern was observed when stratified by each procedure.Conclusions and RelevanceIn this cohort study among Medicare beneficiaries undergoing high-risk surgery, male and female patients experienced similar rates of serious complications, but female patients with complications were more likely to die. In other words, clinicians fail to rescue female patients with complications after high-risk surgery more often than male patients. Improving the recognition and management of female patients’ complications postoperatively may narrow the sex disparity after high-risk surgery.

中文翻译：

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未能抢救接受高危手术的女性患者


重要性女性患者在高危手术后的死亡率高于男性患者。目前尚不清楚这种死亡率差距是由于术后并发症的发生率不同，还是因性别而异，导致并发症导致死亡——所谓的抢救失败。目的评估高危外科手术中抢救失败的性别差异。设计、设置和参与者这项回顾性队列研究是使用 2015 年 10 月至 2020 年 2 月接受高危血管或心脏外科手术的 Medicare 受益人的数据进行的，包括腹主动脉瘤修复术、冠状动脉旁路移植术、主动脉瓣置换术和二尖瓣置换术或修复术。数据分析于 2023 年 8 月至 2024 年 3 月进行。主要结局和措施主要结局是风险调整后的并发症发生率、30 天死亡率和抢救失败，抢救失败定义为严重并发症后发生的死亡。分类变量以频率和比例表示，并使用 χ2 分析进行比较。检验连续变量的正态性并使用 t 检验进行比较。结果本研究队列共纳入 863 305 名 Medicare 受益人，其中 304 176 名 （35.2%） 为女性。女性患者的平均 （SD） 年龄 （74.8 [9.3] 岁） 略高于男性患者 （73.4 [8.5] 岁），女性患者的合并症多于男性患者 （≥2 Elixhauser 合并症，女性：262 809 [86.4%] vs 男性：465 231 [83.2%]）。女性患者更有可能在大型医院和手术病例量较高的医院接受护理。 总体而言，女性和男性患者的并发症发生率相似（女性：14.98% vs 男性：14.37%;调整后相对风险 [aRR]，1.04;95% CI，1.03-1.05;P < .001）。然而，女性患者的 30 天死亡率更高（女性：4.22% vs 男性：3.34%;aRR，1.26;95% CI，1.23-1.29;P < .001）和较高的救援失败率（女性：10.71% vs 男性：8.58%;aRR，1.25;95% CI，1.22-1.28;P < .001）。当按每个程序分层时，观察到类似的模式。结论和相关性在这项针对接受高危手术的 Medicare 受益人的队列研究中，男性和女性患者的严重并发症发生率相似，但有并发症的女性患者更有可能死亡。换句话说，临床医生比男性患者更频繁地抢救高危手术后出现并发症的女性患者。提高对女性患者术后并发症的识别和管理可能会缩小高危手术后的性别差异。