Female Patients More Likely To Die From Surgical Complications After High-Risk Procedures: Study

Researchers suggest that a key problem may be doctors using the same benchmarks when diagnosing surgical complications among men and women, despite important biological differences.

Although doctors report that men and women experience similar surgical complication rates after complex procedures, new research suggests that women are more likely to die from those complications, due to disparities between the genders in recognizing and responding to the problems.

It is well known that female patients die more often than male patients following high-risk surgery. Although researchers have always believed it was because women suffer more complications than men, new data seems to suggest otherwise.

In a study published in the medical journal JAMA Surgery on October 16, researchers found that the surgical complication rates between men and women are similar.  However, female patients have higher “failure to rescue” rates.

In the medical field, “failure to rescue” refers to patients who suffer complications that are often easily treated but instead result in death. Therefore, researchers indicate that improving the recognition and management of female patients’ complications after high-risk surgery may help narrow the disparity in outcomes between women and men.

In this new study, a team of researchers led by Dr. Catherine M. Wagner, of the University of Michigan, studied data from 863,000 Medicare patients undergoing high-risk surgery from October 2015 to February 2020. Female and male patients 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.

There were 304,000 female patients included in the study, representing about 35% of participants. On average, female patients were 75 years old and male patients were 73 years old.

According to the findings, about 15% of women experienced complications, compared to a nearly-identical 14% of men. Patients suffered complications like heart attacks, kidney failure, pulmonary embolisms, pneumonia, surgical-site infections and major blood loss.

However, the findings indicate that when those complications arose, doctors were less likely to save female patients than male patients, resulting in more deaths for female patients. The researchers determined that women had a 4.22% 30-day death rate, compared to men, at 3.34%. Women also faced higher rates of failure to save at 10.7% compared to 8.6% for men.

“In other words, clinicians fail to rescue female patients with complications after high-risk surgery more often than male patients,” Wagner’s team concluded. They determined that the data ruled out differences like the size of the hospital, the number of nurses per patient, and how many procedures were performed as potential factors.

Researchers said one possibility for the failure to save rates is that the diagnostic algorithms hospitals use to flag and treat complications are treated the same among men and women. This could lead to misdiagnosis or failure to diagnose, since women have different health markers and levels of normal and abnormal than men. For example, symptoms of heart attack are often much different in women than in men.

They concluded that it is important for doctors to recognize biological differences in disease between men and women. In this way, they can manage and respond to complications differently based on sex, so as to help reduce the risk of death to women.