R. L. Massoumi1, C. Tom2, E. Howell2, C. P. Childers1, R. Sakai-Bizmark3,4, S. L. Lee1,5 1University Of California – Los Angeles,Surgery,Los Angeles, CA, USA 2Harbor-UCLA,Surgery,Torrance, CA, USA 3Los Angeles Biomedical Research Institute,Torrance, CA, USA 4Harbor-UCLA,Pediatrics,Torrance, CA, USA 5UCLA Mattel Children’s Hospital,Pediatric Surgery,Los Angeles, CA, USA
Introduction:
While male and female patients are known to have varied responses to medical interventions, how sex influences surgical outcomes has not yet been clearly elucidated. Data are particularly lacking in children. Our study aimed to determine the effect of sex on surgical outcomes after pyloromyotomy.
Methods:
Using the Kids’ Inpatient Database (KID) for the years 2003, 2006, 2009, and 2012, we performed a retrospective review of all patients under 1 year of age who underwent pyloromyotomy for hypertrophic pyloric stenosis. Endpoints included patient mortality, any complications during their hospitalization (derived from ICD-9 codes and including during procedure, gastrointestinal, respiratory, or cardiovascular), hospital cost (calculated using cost to charge ratios), and total length of hospital stay (LOS). The primary comparison was outcomes for males versus females. Regression models were adjusted by race, age group and complications with region and year fixed effects. Hierarchical logistic regression was used for complication and mortality rates, hierarchical negative binomial regression was used to assess LOS, and hierarchical multivariable linear regression was performed for cost analysis.
Results:
Of 51,298 weighted operations reviewed, 41,331 (80.6%) were in males and 9,967 (19.4%) were in females. There was no statistically significant difference in distribution of races between the two genders. Female patients were more likely to be greater than 29 days old on the day of operation (83.4% of females versus 79.5% of males P < 0.001). Multivariable analysis comparing males and females is summarized in Table 1. Females had a higher risk of patient mortality, complications, LOS, and cost.
Conclusion:
Our study demonstrated that females had worse outcomes following pyloromyotomy compared to males. Females had increased mortality, complications, LOS, and cost. These findings are striking and are important to consider when treating either sex to help set physician and family expectations perioperatively. Further studies are needed to determine why such differences exist to develop targeted treatment strategies for both females and males with pyloric stenosis.
