H. Alshaikh1, S. Selvarajah1, N. Nagarajan1, F. Gani1, C. K. Zogg1, H. Alturki1, A. Najafian1, D. T. Efron2, C. G. Velopulos2, E. B. Schneider1, A. H. Haider1 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA
Introduction: Multiple studies have demonstrated gender dimorphism in survival after trauma-induced hemorrhage. These findings have led to gender based therapeutics such as the administration of progesterone to males after injury. However, the potential survival benefit females may enjoy has not been well studied in non-traumatic emergency situations such as gastrointestinal (GI) hemorrhage. The objective of this study was to examine the association between gender and survival in patients presenting with acute non-traumatic GI hemorrhage using a nationally representative database.
Methods: Using Nationwide Inpatient Sample (NIS) data from 2007-2011, adults admitted through the emergency department with GI hemorrhage were identified using ICD-9 diagnosis code (578.*). Patients <18 years of age were excluded as were patients with missing demographic information and elective admissions. Weighted univariate and multivariable logistic regression was done to assess the relationship between gender and in-hospital mortality. The adjusted analysis controlled for demographic factors, hospital characteristics, patient transfer status and patient clinical severity. Severity was assessed using All-Patient Refined Diagnosis-Related Group (APR-DRG) severity scores.
Results: A total of 809,798 weighted inpatient visits met the inclusion criteria, 51% of patient were female. Mean age was higher for women compared with men (72.1 vs. 65.8, p<0.001). Non-operative intervention was common among therapeutic options, including esophagogastroduodenoscopy (27.5%), small intestine endoscopy (26.5%) and colonoscopy (16.9%). About 43.9% of patients received blood transfusion, with higher proportion of women receiving them (51.7% vs. 48.3%, p<0.001). The proportion of patients with APR-DRG severity scores 1 and 2 (non-severe) was 52.9% for females (95%CI=52.3-53.6) and 52.4% for males (95%CI=51.7-53.1). Women demonstrated 14% lower unadjusted odds of death compared with men (OR 0.86, 95% CI 0.82-0.91). Moreover after adjustment, women demonstrated 22% lower odds of in-hospital mortality compared with men (OR 0.78, 95% CI 0.74-0.82). Alternative regression models were consistent with these results.
Conclusion: Females demonstrated significantly lower mortality after emergent GI hemorrhage despite controlling for severity and age. This evidence, in conjunction with other studies that demonstrate lower female mortality in traumatic hemorrhage, should prompt researchers to further investigate potential gender-related physiological pathways that could be altered by novel therapeutic options to improve patient outcomes.