Pub Date : 2024-10-30DOI: 10.1001/jamasurg.2024.4698
Emily Smith, Laura Young, Faisal G Bakaeen
{"title":"The Ongoing Dilemma of Timing Noncardiac Surgery After NSTEMI.","authors":"Emily Smith, Laura Young, Faisal G Bakaeen","doi":"10.1001/jamasurg.2024.4698","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4698","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1001/jamasurg.2024.3403
Aaron Erickson,Nina M Clark,Dana C Lynge
{"title":"A Call for Standardization in Rural Surgery Training.","authors":"Aaron Erickson,Nina M Clark,Dana C Lynge","doi":"10.1001/jamasurg.2024.3403","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3403","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"109 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1001/jamasurg.2024.4699
Charlotte M Rajasingh, Sherry M Wren
{"title":"Patient-Centered Outcomes and Preoperative Discussions.","authors":"Charlotte M Rajasingh, Sherry M Wren","doi":"10.1001/jamasurg.2024.4699","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4699","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1001/jamasurg.2024.4359
Ri-Hui Xiong,Zhao-Ping Wu,Deng-Chao Wang
{"title":"Limitations in Gauging the Effects of Allocation Policy Changes on Liver Transplant.","authors":"Ri-Hui Xiong,Zhao-Ping Wu,Deng-Chao Wang","doi":"10.1001/jamasurg.2024.4359","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4359","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"23 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1001/jamasurg.2024.4362
Maria Bernadette Majella Doyle,Ola Ahmed,Susan L Orloff
{"title":"Limitations in Gauging the Effects of Allocation Policy Changes on Liver Transplant-Reply.","authors":"Maria Bernadette Majella Doyle,Ola Ahmed,Susan L Orloff","doi":"10.1001/jamasurg.2024.4362","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4362","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"211 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1001/jamasurg.2024.4691
Michael A Jacobs,Carly A Jacobs,Orna Intrator,Rajesh Makineni,Ada Youk,Monique Y Boudreaux-Kelly,Jennifer L McCoy,Bruce Kinosian,Paula K Shireman,Daniel E Hall
ImportanceMajor surgery sometimes involves long recovery or even permanent institutionalization. Little is known about long-term trajectories of postoperative recovery, as surgical registries are limited to 30-day outcomes and care can occur across various institutions.ObjectiveTo characterize long-term postoperative recovery trajectories.Design, Setting, and ParticipantsThis retrospective cohort study used Veterans Affairs (VA) Surgical Quality Improvement Program data (2016 through 2019) linked to the Residential History File, combining data from the VA, Medicare/Medicaid, and other sources to capture most health care utilization by days. Patients were divided into younger (younger than 65 years) or older (65 years or older) subgroups, as Medicare eligibility is age dependent. Latent-class, group-based trajectory models were developed for each group. These data were analyzed from February 2023 through August 2024.ExposureSurgical care in VA hospitals.Main Outcomes and MeasuresDays elsewhere than home (DEH) were counted in 30-day periods for 275 days presurgery and 365 days postsurgery.ResultsA 5-trajectory solution was optimal and visually similar for both age groups (cases: 179 879 younger [mean age (SD) 51.2 (10.8) years; most were male [154 542 (83.0%)] and 198 803 older [mean (SD) age, 72.2 (6.0) years; 187 996 were male (97.6%)]). Most cases were in trajectories 1 and 2 (T1 and T2). T1 cases returned home within 30 days (younger, 74.0%; older, 54.2%), while T2 described delayed recovery within 30 to 60 days (younger, 21.6%; older, 35.5%). Trajectory 3 (T3) and trajectory 4 (T4) were similar for the first 30 days postsurgery, but subsequently separated with T3 representing protracted recovery of 6 months or longer (younger, 2.7%; older, 3.8%) and T4 indicating long-term loss of independence (younger, 1.3%; older, 5.2%). Few (trajectory 5) were chronically dependent, with 20 to 30 DEH per month before and after surgery (younger, 0.4%; older, 1.3%).Conclusions and RelevanceIn this study, trajectory models demonstrated clinically meaningful differences in postoperative recovery that should inform surgical decision-making. Registries should include longer-term outcomes to enable future research to distinguish patients prone to long-term loss of independence vs protracted, but meaningful recovery.
{"title":"Long-Term Trajectories of Postoperative Recovery in Younger and Older Veterans.","authors":"Michael A Jacobs,Carly A Jacobs,Orna Intrator,Rajesh Makineni,Ada Youk,Monique Y Boudreaux-Kelly,Jennifer L McCoy,Bruce Kinosian,Paula K Shireman,Daniel E Hall","doi":"10.1001/jamasurg.2024.4691","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4691","url":null,"abstract":"ImportanceMajor surgery sometimes involves long recovery or even permanent institutionalization. Little is known about long-term trajectories of postoperative recovery, as surgical registries are limited to 30-day outcomes and care can occur across various institutions.ObjectiveTo characterize long-term postoperative recovery trajectories.Design, Setting, and ParticipantsThis retrospective cohort study used Veterans Affairs (VA) Surgical Quality Improvement Program data (2016 through 2019) linked to the Residential History File, combining data from the VA, Medicare/Medicaid, and other sources to capture most health care utilization by days. Patients were divided into younger (younger than 65 years) or older (65 years or older) subgroups, as Medicare eligibility is age dependent. Latent-class, group-based trajectory models were developed for each group. These data were analyzed from February 2023 through August 2024.ExposureSurgical care in VA hospitals.Main Outcomes and MeasuresDays elsewhere than home (DEH) were counted in 30-day periods for 275 days presurgery and 365 days postsurgery.ResultsA 5-trajectory solution was optimal and visually similar for both age groups (cases: 179 879 younger [mean age (SD) 51.2 (10.8) years; most were male [154 542 (83.0%)] and 198 803 older [mean (SD) age, 72.2 (6.0) years; 187 996 were male (97.6%)]). Most cases were in trajectories 1 and 2 (T1 and T2). T1 cases returned home within 30 days (younger, 74.0%; older, 54.2%), while T2 described delayed recovery within 30 to 60 days (younger, 21.6%; older, 35.5%). Trajectory 3 (T3) and trajectory 4 (T4) were similar for the first 30 days postsurgery, but subsequently separated with T3 representing protracted recovery of 6 months or longer (younger, 2.7%; older, 3.8%) and T4 indicating long-term loss of independence (younger, 1.3%; older, 5.2%). Few (trajectory 5) were chronically dependent, with 20 to 30 DEH per month before and after surgery (younger, 0.4%; older, 1.3%).Conclusions and RelevanceIn this study, trajectory models demonstrated clinically meaningful differences in postoperative recovery that should inform surgical decision-making. Registries should include longer-term outcomes to enable future research to distinguish patients prone to long-term loss of independence vs protracted, but meaningful recovery.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"34 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1001/jamasurg.2024.4093
Sara Sakowitz,Syed Shahyan Bakhtiyar,Saad Mallick,Jane Yanagawa,Peyman Benharash
{"title":"Outcomes Following Resection of Stage I to III Thymic Tumors in High-Volume Centers.","authors":"Sara Sakowitz,Syed Shahyan Bakhtiyar,Saad Mallick,Jane Yanagawa,Peyman Benharash","doi":"10.1001/jamasurg.2024.4093","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4093","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"11 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1001/jamasurg.2024.2741
Peter T Hetzler,Ryan D Katz
{"title":"A Primer on Optimizing Ergonomics in the Operating Room.","authors":"Peter T Hetzler,Ryan D Katz","doi":"10.1001/jamasurg.2024.2741","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.2741","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"16 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1001/jamasurg.2024.4580
Tara A Russell,Ryu Yoshida,Mauranda Men,Ruixin Li,Melinda Maggard-Gibbons,Christian de Virgilio,Marcia M Russell,Yusuke Tsugawa
ImportanceThere are 2 degree programs for licensed physicians in the US: allopathic medical doctorate (MD) and osteopathic doctorate (DO). However, evidence is limited as to whether outcomes differ between patients treated by MD vs DO surgeons.ObjectiveTo evaluate differences in surgical outcomes and practice patterns by surgeon medical school training (MD vs DO).Design, Setting, and ParticipantsThis retrospective cohort study used 100% Medicare claims data from inpatient hospitals providing surgical services from January 1, 2016, to December 31, 2019 among Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of the 14 most common surgical procedures. Data analysis was performed from January 17, 2023, to August 13, 2024.ExposureMedical school degree (MD vs DO).Main Outcomes and MeasuresThe primary outcome was 30-day mortality, and the secondary outcomes were readmissions and length of stay. To assess differences between surgeons by medical school training, a multivariable linear probability model was used, which was adjusted for hospital fixed effects and patient, procedure, and surgeon characteristics.ResultsOf the 2 360 108 total surgical procedures analyzed, 2 154 562 (91.3%) were performed by MD surgeons, and 205 546 (8.7%) were performed by DO surgeons. Of 43 651 total surgeons, most surgeons were MDs (39 339 [90.1%]), the median (SD) age was 49.0 (9.8) years, and 6649 surgeons (15.2%) were female. The mean (SD) age of patients undergoing surgical procedures was 74.9 (6.7) years, 1 353 818 of 2 360 108 patients (57.4%) were female, and 2 110 611 patients (89.4%) self-reported as White. DO surgeons were significantly more likely to operate on older patients (DO patient mean [SD] age: 75.3 [7.1] years; MD patient mean [SD] age: 74.8 [6.6]), female patients (DO: 60.2% of patients; MD: 57.1% of patients), and Medicaid dual-eligible patients (DO: 10.3% of patients; MD: 8.6% of patients). DOs performed a lower proportion of elective operations (DO: 74.2% vs MD: 80.2%) and were more likely to work in public hospitals (DO: 10.3%; MD: 9.5%) and nonteaching hospitals (DO: 57.9%; MD: 68.1%). There was no evidence that 30-day mortality differed between MD and DO surgeons (adjusted mortality rate, DO: 1.61%; MD: 1.58%; absolute risk difference [aRD], -0.04 percentage points; 95% CI, -0.11 to 0.04; P = .37). On secondary analyses, no difference was found in 30-day readmissions or length of stay between MD and DO surgeons.Conclusions and RelevanceIn this retrospective cohort study using Medicare data, there was no evidence that patient outcomes differed between MD and DO surgeons for common operations after adjusting for patient factors and practice settings.
{"title":"Comparison of Outcomes for Patients Treated by Allopathic vs Osteopathic Surgeons.","authors":"Tara A Russell,Ryu Yoshida,Mauranda Men,Ruixin Li,Melinda Maggard-Gibbons,Christian de Virgilio,Marcia M Russell,Yusuke Tsugawa","doi":"10.1001/jamasurg.2024.4580","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4580","url":null,"abstract":"ImportanceThere are 2 degree programs for licensed physicians in the US: allopathic medical doctorate (MD) and osteopathic doctorate (DO). However, evidence is limited as to whether outcomes differ between patients treated by MD vs DO surgeons.ObjectiveTo evaluate differences in surgical outcomes and practice patterns by surgeon medical school training (MD vs DO).Design, Setting, and ParticipantsThis retrospective cohort study used 100% Medicare claims data from inpatient hospitals providing surgical services from January 1, 2016, to December 31, 2019 among Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of the 14 most common surgical procedures. Data analysis was performed from January 17, 2023, to August 13, 2024.ExposureMedical school degree (MD vs DO).Main Outcomes and MeasuresThe primary outcome was 30-day mortality, and the secondary outcomes were readmissions and length of stay. To assess differences between surgeons by medical school training, a multivariable linear probability model was used, which was adjusted for hospital fixed effects and patient, procedure, and surgeon characteristics.ResultsOf the 2 360 108 total surgical procedures analyzed, 2 154 562 (91.3%) were performed by MD surgeons, and 205 546 (8.7%) were performed by DO surgeons. Of 43 651 total surgeons, most surgeons were MDs (39 339 [90.1%]), the median (SD) age was 49.0 (9.8) years, and 6649 surgeons (15.2%) were female. The mean (SD) age of patients undergoing surgical procedures was 74.9 (6.7) years, 1 353 818 of 2 360 108 patients (57.4%) were female, and 2 110 611 patients (89.4%) self-reported as White. DO surgeons were significantly more likely to operate on older patients (DO patient mean [SD] age: 75.3 [7.1] years; MD patient mean [SD] age: 74.8 [6.6]), female patients (DO: 60.2% of patients; MD: 57.1% of patients), and Medicaid dual-eligible patients (DO: 10.3% of patients; MD: 8.6% of patients). DOs performed a lower proportion of elective operations (DO: 74.2% vs MD: 80.2%) and were more likely to work in public hospitals (DO: 10.3%; MD: 9.5%) and nonteaching hospitals (DO: 57.9%; MD: 68.1%). There was no evidence that 30-day mortality differed between MD and DO surgeons (adjusted mortality rate, DO: 1.61%; MD: 1.58%; absolute risk difference [aRD], -0.04 percentage points; 95% CI, -0.11 to 0.04; P = .37). On secondary analyses, no difference was found in 30-day readmissions or length of stay between MD and DO surgeons.Conclusions and RelevanceIn this retrospective cohort study using Medicare data, there was no evidence that patient outcomes differed between MD and DO surgeons for common operations after adjusting for patient factors and practice settings.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"24 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1001/jamasurg.2024.4574
Catherine M Wagner,Karen E Joynt Maddox,Gorav Ailawadi,Andrew M Ibrahim
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.
重要性女性患者在高风险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,还是由于不同性别对并发症的处理方式不同,导致并发症导致死亡--即所谓的抢救失败。目的评估高风险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使用了 2015 年 10 月至 2020 年 2 月期间接受高风险血管或心脏手术(包括腹主动脉瘤修补术、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补术)的医疗保险受益人的数据。主要结果和测量指标主要结果是风险调整后的并发症发生率、30 天死亡率和抢救失败率,抢救失败率定义为严重并发症发生后的死亡。分类变量以频率和比例表示,并使用χ2分析进行比较。连续变量进行了正态性检验,并采用 t 检验进行比较。结果共有 863 305 名医疗保险受益人被纳入本研究队列,其中女性 304 176 人(35.2%)。女性患者的平均(标清)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 项 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量较大的医院接受治疗。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),抢救失败率更高(女性:10.71% vs 男性:8.58%;aRR,1.25;95% CI,1.22-1.28;P < .001)。在这项对接受高风险手术的医疗保险受益人进行的队列研究中,男性和女性患者的严重并发症发生率相似,但出现并发症的女性患者更有可能死亡。换句话说,临床医生对高风险手术后出现并发症的女性患者的抢救失败率高于男性患者。改善对女性患者术后并发症的识别和处理,可以缩小高风险手术后的性别差异。
{"title":"Failure to Rescue Female Patients Undergoing High-Risk Surgery.","authors":"Catherine M Wagner,Karen E Joynt Maddox,Gorav Ailawadi,Andrew M Ibrahim","doi":"10.1001/jamasurg.2024.4574","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4574","url":null,"abstract":"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.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"32 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}