Virginia Anesthesia Services LLC Demographic Trends in Surgery Outcomes  - Virginia Anesthesia Services LLC

Demographic Trends in Surgery Outcomes 

Demographic factors like age, race, and gender can have a significant effect on surgery outcomes. In general, patients who are older, women, and patients of color experience higher rates of mortality and postoperative complications compared to their counterparts. These disparities are the result of numerous systemic issues in medicine, including structural racism and implicit sex biases, as well as higher rates of preexisting health conditions in these more vulnerable populations. These demographic trends in surgery outcomes should inform healthcare providers’ care toward their patients and also highlight the need for large-scale changes in the field of medicine. 

One of the most prominent demographic trends in surgery outcomes is the disparity according to race. Racial disparities in surgical outcomes have been widely documented in the medical literature in the United States. For example, one study of older Medicare beneficiaries, Black men experienced higher mortality rates in surgery compared with white men, white women, and black women (3). These differences in the risk of mortality for Black communities can be attributed to structural racism that predisposes Black patients to worse health status (3). 

For example, predominantly Black neighborhoods are more likely to be located near hospitals with fewer resources and clinical specialists with advanced training (3). Black neighborhoods may also be located nearer to environmental health hazards like air pollution from factory waste (3). Surgeons may also believe that Black patients are less likely to experience high levels of pain due to subconscious biases and provide Black patients with a lower level of perioperative care. 

New research is also demonstrating a strong correlation between gender and postoperative outcomes. Alarmingly, one study found that women are 32% more likely to die when their surgery is performed by a male surgeon versus a female surgeon (1). No corresponding association was found for male patients; in fact, men were actually 13% less likely to die when their surgeon was a woman (1). The stark difference in surgical outcomes for men and women is thought to be the result of implicit sexual bias that causes male surgeons to take the ailments of women less seriously and act on sexual stereotypes and biases when treating them. 

Age also has a significant impact on surgical outcomes, as older patients are more likely to have comorbid conditions and underlying health conditions. Cardiovascular disease in particular is a leading cause of death worldwide among the elderly population. One study of patients who underwent coronary artery bypass grafting—in which a blood vessel from the chest or leg area is used to create a new path around a blocked artery—compared the surgery outcomes between 70-79-year-old patients and 80-89-year-old patients (2). The study found that patients who were in their eighties were more likely to experience complications and had higher rates of mortality and postoperative bleeding compared to patients in their seventies (2). 

As the population in the United States grows older and more diverse, it is essential to address these demographic trends in surgery outcomes to reduce health disparities. More medical and public health research as well as interdisciplinary research in sociology is necessary to understand how deep-seated sociological, environmental, and health factors contribute to unequal surgical outcomes among various populations. 

References 

  1. Campbell, Denis. “Women 32% more likely to die after operation by male surgeon, study reveals.” The Guardian, 4 Jan 2022, https://www.theguardian.com/society/2022/jan/04/women-more-likely-die-operation-male-surgeon-study 
  1. Lemaire, A., Soto, C., Salgueiro, L. et al. The impact of age on outcomes of coronary artery bypass grafting. J Cardiothorac Surg 15, 158 (2020). https://doi.org/10.1186/s13019-020-01201-3 
  1. Ly D P, Blegen M B, Gibbons M M, Norris K C, Tsugawa Y. Inequities in surgical outcomes by race and sex in the United States: retrospective cohort study BMJ 2023; 380 :e073290 doi:10.1136/bmj-2022-073290 
  1. Wallis CJD, Jerath A, Coburn N, et al. Association of Surgeon-Patient Sex Concordance With Postoperative Outcomes. JAMA Surg. 2022;157(2):146–156. doi:10.1001/jamasurg.2021.6339