Study: Women more likely to die from postoperative complications after high-risk surgery

Editor's Note

Female patients undergoing high-risk surgeries are significantly more likely to die from postoperative complications despite experiencing complications at similar rates, according to findings published October 16 in JAMA. Observed in a cohort of 863,305 Medicare beneficiaries, this disparity suggests that clinicians may be less effective at recognizing and addressing complications in female patients, a phenomenon known as "failure to rescue," researchers write.

The study analyzed data from 2015 to 2020, focusing on patients who underwent common high-risk procedures such as abdominal aortic aneurysm repair, coronary artery bypass grafting, aortic valve replacement, and mitral valve replacement or repair. The researchers compared the outcomes of male and female patients, adjusting for age, comorbidities, and hospital characteristics.

Both male and female patients experienced similar rates of serious complications—14.98% for women and 14.37% for men. However, women were more likely to die within 30 days of surgery (4.22% vs. 3.34%) and more likely to experience failure to rescue (10.71% vs. 8.58%). This disparity persisted across all studied procedures.

The findings indicate that the higher mortality rate in women is not due to more frequent or severe complications but rather to a potential gap in the recognition and timely intervention of complications, researchers write.  Previous research has shown that female patients often face delays in diagnosis and intervention for conditions like heart attacks and strokes, which may contribute to worse outcomes following surgery as well.

According to researchers, improving the recognition and management of postoperative complications in women could involve addressing implicit biases in clinical decision-making, increasing awareness of sex differences in symptom presentation, and improving institutional protocols for postoperative care.