Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2026
Racial and Sex Differences in Postoperative Mortality Between Patients With Versus Without Dementia.
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Yoshida Ryu, Nuckols Teryl K, Norris Keith, Maggard-Gibbons Melinda, de Virgilio Christian, Klomhaus Alexandra, Li Ruixin, Li Yu Jun, Tsugawa Yusuke, Gotanda Hiroshi
Аннотация
OBJECTIVE: To compare racial-sex differences in postoperative mortality by dementia status.
BACKGROUND: Because patients with dementia often find it harder to advocate for themselves, racial-sex differences in postoperative mortality may be greater for patients with dementia versus without dementia.
METHODS: Among Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent one of 12 common surgical procedures in 2016 to 2019, we compared 30-day postoperative mortality (death during the index hospitalization or within 30 days of surgery) across 4 race-sex groups (Black men [reference group], White men, White women, and Black women) stratified by dementia status. Elective and nonelective surgeries were examined separately.
RESULTS: Among 888,391 patients undergoing elective surgery, 65,450 (7.4%) had dementia. Postoperative mortality was highest among Black men, both with dementia (adjusted mortality, 3.99%) and without dementia (2.11%). Racial-sex differences were generally greater among patients with dementia. For example, the mortality difference between White women versus Black men was significantly larger among patients with dementia (adjusted difference, -2.38 percentage points [pp]; 95% confidence interval [CI], -3.34 to -1.41) than among those without dementia (-0.75 pp; 95% CI, -0.96 to -0.54) (P-for-interaction = 0.001). In contrast, among 394,554 patients undergoing nonelective surgery, 56,273 (14.3%) had dementia, and we found no evidence that mortality was highest among Black men or that racial-sex differences meaningfully varied by dementia status.
CONCLUSIONS: Among patients undergoing elective surgery, racial-sex differences in postoperative mortality were greater among patients with dementia than among those without dementia, highlighting the need for targeted strategies to ensure consistent surgical care.
BACKGROUND: Because patients with dementia often find it harder to advocate for themselves, racial-sex differences in postoperative mortality may be greater for patients with dementia versus without dementia.
METHODS: Among Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent one of 12 common surgical procedures in 2016 to 2019, we compared 30-day postoperative mortality (death during the index hospitalization or within 30 days of surgery) across 4 race-sex groups (Black men [reference group], White men, White women, and Black women) stratified by dementia status. Elective and nonelective surgeries were examined separately.
RESULTS: Among 888,391 patients undergoing elective surgery, 65,450 (7.4%) had dementia. Postoperative mortality was highest among Black men, both with dementia (adjusted mortality, 3.99%) and without dementia (2.11%). Racial-sex differences were generally greater among patients with dementia. For example, the mortality difference between White women versus Black men was significantly larger among patients with dementia (adjusted difference, -2.38 percentage points [pp]; 95% confidence interval [CI], -3.34 to -1.41) than among those without dementia (-0.75 pp; 95% CI, -0.96 to -0.54) (P-for-interaction = 0.001). In contrast, among 394,554 patients undergoing nonelective surgery, 56,273 (14.3%) had dementia, and we found no evidence that mortality was highest among Black men or that racial-sex differences meaningfully varied by dementia status.
CONCLUSIONS: Among patients undergoing elective surgery, racial-sex differences in postoperative mortality were greater among patients with dementia than among those without dementia, highlighting the need for targeted strategies to ensure consistent surgical care.