The effect of gender on postoperative mortality after emergency abdominal surgery.

Background: The factors contributing to the high mortality after emergency abdominal surgery are unclear. Recent studies have revealed gender differences in immune function after trauma and in the presence of sepsis.

Objective: This study tested the hypothesis that factors determining survival after emergency abdominal surgery differ in males and females.

Methods: Consecutive patients, aged > or =50 years, who underwent emergency abdominal surgery between July 1998 and June 2000 at the Royal and Western Infirmaries in Glasgow, Scotland, were identified for study. Data collected retrospectively included sex, age, severity of surgery, seniority of surgeon and anesthetist, extent of deprivation, and 30-day postoperative mortality.

Results: A total of 633 patients were identified for study; 49 (8%) were excluded from analysis because 30-day mortality or surgery details were unavailable. Of the remaining 584 patients, 256 were male and 328 were female. The overall 30-day mortality was 26%, with 74 (29%) males and 79 (24%) females dying within this period. The mortality rates were 25% in males and 10% in females (P = 0.043) after minor surgery, 26% in males and 23% in females (P = NS) after intermediate surgery, and 44% in males and 39% in females (P = NS) after major surgery. On univariate logistic regression analysis in males, increasing age (P < 0.001), severity of surgery (P = 0.04), and seniority of anesthetist (P < 0.001) were associated with mortality. In females, severity of surgery (P < 0.001) was associated with mortality.

Conclusions: These results show that in females, 30-day mortality was determined by severity of surgery, whereas in males increasing age and seniority of anesthetist also influenced 30-day mortality.