Sex-based differences in mortality and failure to rescue after major gastrointestinal cancer resections: real-world evidence from a nationwide cohort.

BACKGROUND

Sex-based differences in outcomes after oncological surgery remain underexplored despite growing interest in personalized and equitable cancer care. Sex differences in in-hospital mortality and failure-to-rescue rates after major gastrointestinal cancer surgery were analysed using nationwide real-world data.

METHODS

German Diagnosis Related Groups discharge data from 2010-2023 were analysed, including adult patients undergoing curative-intent resections for colorectal, gastric, pancreatic, and oesophageal cancers. Multivariable generalized linear models were applied to estimate adjusted sex-specific risks of in-hospital mortality and failure to rescue.

RESULTS

Among 870 754 patients (376 883, 43.3% women), the overall in-hospital mortality rate was 5.9%. Women had lower adjusted odds of death (20 343 (5.4%) versus 31 265 (6.3%); adjusted odds ratio 0.82, 95% confidence interval 0.81 to 0.84) and failure to rescue (18 097 of 151 616 (11.9%) versus 28 583 of 231 245 (12.4%); adjusted odds ratio 0.92, 0.89 to 0.94) compared with men. The mortality advantage for women was consistent across cancer sites except for oesophageal resection. Temporal analyses showed a continuous decline in mortality and failure to rescue for both sexes over the 14-year study period.

CONCLUSION

Female sex was independently associated with lower in-hospital mortality and failure-to-rescue rates after major gastrointestinal cancer surgery in routine clinical practice. Male sex was associated with a higher risk of adverse short-term outcomes, identifying men as a higher-risk group in routine oncological surgical care. Although causal mechanisms cannot be inferred, the results suggest the need for sex-informed perioperative management and rescue strategies to improve the quality of oncological surgical care.